Another reaction to the SCOTUS overturning the Chevron Doctrine

Posted on August 17, 2024 by Pharmaciststeve

In 2022 the SCOTUS told the EPA & ATF that they did not have the statutory authority to create new interpretations of the laws they were in charge of enforcing.  The SCOTUS did not tell the DEA that they did not have the authority to create new interpretations of the Control Substance Act in 2022. However, this year the SCOTUS overturned the Chevron Doctrine. Which basically make it universally ILLEGAl for any federal agency to make new interpretations of laws that they were in charge of enforcing.

While the article below may seem like an apple vs oranges comparison. Maybe the ATF initially chose to ignore the SCOTUS and decided after the overturning of the Chevron Doctrine, that they better get their act together.  The DEA has created SO MANY new interpretations of the Control Substance Act over the years, could the community be just ONE LAWSUIT AWAY from having the DEA rescind all of those now illegal interpretations of the CSA?

ATF To Return Bump Stocks After 5 Years!

https://bearingarms.com/tomknighton/2024/08/13/atf-returns-bump-stock-after-five-years-n1225905

Bump stocks are no longer illegal. They never should have been, but the ATF decided they would be and we didn’t have any real say in the matter. Sure, there was a comment period, but does anyone really believe the ATF actually pays attention to what anyone says during that time?I didn’t think so.

But thanks to Cargill, the regulation–can we really call it a law?–is as dead as Trump’s would-be assassin.

And now, the ATF has returned at least one bump stock to its rightful owner, David Codrea.

Agents of the Bureau of Alcohol, Tobacco, Firearms and Explosives Independence Ohio Field Office surrendered what ATF had classified as a “FIREARM: OTHER FIREARM… TYPE: MACHINE GUN” to this correspondent Friday, returning property held in a vault since 2019. It was, in fact, a bump stock, once more deemed not a machine gun and “legal” to own following the United State Supreme Court’s landmark Cargill ruling.

This column reported in July that ATF had emailed attorney Stephen Stamboulieh to provide a field office contact so that pickup could be arranged.

That done, the drive from my home to the field office (accompanied by my wife, Maureen) took about half an hour and ended at some pretty nice digs, with marble walls and floors, “gold” trim and an indoor lobby fountain. ATF keeps offices on the seventh floor, with a security anteroom displaying portraits of Director Steve Dettelbach, Attorney General Merrick Garland, Vice President Kamala Harris, and President Joe Biden, leading directly into a conference room affording a killer view of the Cleveland skyline on the horizon.

One agent met us at the elevator and escorted us to the anteroom, where we were met and brought into the meeting room by the RAC (Resident Agent in Charge) and a TFO (Task Force Officer). They were both respectful and cordial and seemingly understanding of how untenable it is to repeatedly go back and forth from legal to illegal. I asked if anyone else had come to reclaim their property and was told I was the only one, that others had forfeited theirs, and that one business that had made stocks wrote the loss off on taxes.

Codrea bought the bump stock explicitly to challenge the law–he didn’t even own the model of gun that particular stock was designed for–and I get that. I respect it, even. The truth is that the rule was never right or constitutional, particularly with how it was foisted onto the American people.

Oh, I get the rationale for doing it that way. Congress was in the process of passing a much more restrictive measure and a lot of Republicans were signing on in the wake of Las Vegas. This minimized the damage.

But political considerations are one thing, the Constitution is another.

Even a congressionally passed law would have been unconstitutional. That would have been challenged in court and probably overturned as a gross overstepping of congressional authority.

For now, Codrea got his gun back and he notes above how even the ATF agents understand how ridiculous it is for something to be legal, then illegal, then legal again, then illegal again. It’s stupid and we all know it. How could they not know it?

I’m disappointed that so many people forfeited theirs. I get the business doing it, mind you, because you don’t want to have to keep paying taxes on inventory you’re not sure you’ll ever be able to sell, but I’d have liked to see more people not forfeit their stocks so as to make a point.

Then again, how many even realized there was an option beyond forfeiture? How many just held onto their stocks and waited?

There’s no way of knowing and it’s kind of a moot point now. The ban is over, at least for now, and people like Codrea got their bump stock back. My hope is that the ATF is done playing these games. Laws shouldn’t be created by executive fiat, which is what happened, and the ATF got slapped down over it. I hope they won’t try it again.

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Digital Tyranny

Posted on August 16, 2024 by Pharmaciststeve

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Push to end drug treatment discrimination

Posted on August 16, 2024 by Pharmaciststeve



Is this a good example of why our judicial system should not be in charge of dealing with people and addictions? The recommendation to this person is that he should get off his medication and use ABSTINENCE to maintain his sobriety. Does this suggest that those within/around our judicial system consider addictions a CHOICE?

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Medicare Advantage woes pose growing threat to hospitals: S&P

Posted on August 16, 2024 by Pharmaciststeve

Medicare Advantage woes pose growing threat to hospitals: S&P

https://www.beckershospitalreview.com/finance/medicare-advantage-woes-pose-growing-threat-to-hospitals.html

As Medicare Advantage continues to grow and health insurers prioritize their margins in the segment, hospitals are the most vulnerable healthcare provider to rising administrative and financial MA burdens, according to a new report from S&P Global.

The Aug. 15 report shared with Becker’s highlights the major growth Medicare Advantage has seen over the last several years, with 32.8 million people, or 54% of the eligible Medicare population, now enrolled in an MA plan.

“This growth poses challenges to healthcare service providers’ credit quality, given growing risks to reimbursement from MA plans relative to traditional Medicare, as well as the payment risk and higher complexity around prior authorization requirements,” S&P’s analysts wrote. “We also see future risks to providers if at some point CMS addresses the MA program’s higher-than-expected spending.”

As MA enrollment has grown, so too have the financial headwinds facing major carriers — government scrutiny is rising, CMS regulations and payments are tightening, and the cost of care is rising.

In response, Aetna, Humana and Centene are among the insurers that have said they will exit some markets in 2025 — and potentially reduce benefit offerings — to accommodate the changing reimbursement environment and rising costs. Notably, UnitedHealthcare and Elevance Health have said they are prepared to weather the changing landscape and priced their 2025 MA plans to reflect that.

“However, if already elevated utilization rates remain high for an extended period we would expect payors to further squeeze payments to providers,” S&P’s analysts wrote. “Overall, we expect these challenges coupled with further expansion of MA as a percentage of total Medicare beneficiaries will continue to pressure margins on the Medicare portion of the provider payor mix.”

“Thus, we expect insurers to prioritize margin over membership, and we expect large insurers will use their scale and market clout to limit provider rate increases over what will prove to be a challenging contract negotiation season.”

In 2023, Becker’s began reporting on hospitals and health systems nationwide that dropped some or all of their Medicare Advantage contracts in response to administrative and financial challenges. In 2024, at least 17 systems have ended an MA contract with an insurer.

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Heat spells trouble for mail-order medications

Posted on August 14, 2024 by Pharmaciststeve

Heat spells trouble for mail-order medications

https://www.beckershospitalreview.com/pharmacy/heat-spells-trouble-for-mail-order-medications.html

Mail-order pharmacies run well-coordinated supply chain operations to ensure medications are safely delivered to patients’ doorsteps, but extreme temperatures are complicating the process, The New York Times reported Aug. 13.

Pharmacists and physicians told the Times that high temperatures inside delivery trucks could cause certain medications such as insulin or epinephrine injectors to overheat, degrade and become less effective.

Delivery drivers have reported temperatures as high as 150 degrees Farenheit inside their trucks, which far exceeds national drug handling standards of 68 to 77 degrees. A 2023 study published in the Journal of the American Pharmacists Association also found that simulated medication shipments spent 68.3% of transit time outside acceptable temperature ranges across all shipment methods, carriers and seasons. In addition, FDA regulations do not apply to medications being transported to patients, leaving oversight to state authorities. 

The Times interviewed more than a dozen patients who said they believed their medications were damaged by heat and humidity in transit. In some cases, patients reported serious health issues after taking the drugs, according to the report. 

Mail-order pharmacies said they use special precautions to protect the integrity of temperature-sensitive drugs, including weather-resistant packaging. Bryan Rabakon, senior vice president of supply chain and engineering for OptumRx, told the Times it monitors the duration of shipments and automatically sends a new package if transit times exceed a certain threshold. The company discontinued use of temperature-sensitive tags due to a high rate of false positives, he said. Cigna, which owns Express Scripts, did not respond to the Times’ request for comment. 

Read the full article here.

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Why are pharmacy chains failing

Posted on August 7, 2024 by Pharmaciststeve

Collectively we are in the process of 10,000+ pharmacies have or will be closing.  Many of the major mail-order pharmacies are owned by the same major insurance/pbm companies, and they will be pushing and creating financial incentives for people to use them currently, they are pushing back on state pharmacy boards that are trying to create requirements that mail order prescriptions be properly shipped and protecting against ambient temperatures that can/may harm medications in shipment.  If/when all these pharmacies close their doors, one can just imagine all the long lines and wait times for pts to get their medications, as well as how far the pt is going to travel to get their Rxs filled.  Back in the day, most people patronized a particular pharmacy, the pharmacy was within 2 miles of their home or where they worked.

Study Shows Mail-Order Prescriptions May Be Often Exposed to Unsafe Temperatures

FTC Deepens Inquiry into Prescription Drug Middlemen

Cash crunch pushes independents to the brink, data shows PBMs the cause

Walgreens will close a significant number of US stores, shutting down many unprofitable locations

Rite Aid Bankruptcy Explained: Three Reasons Why Pharmacy Giant Failed

 

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Where VP picks stand on pharmaceutical costs

Posted on August 6, 2024 by Pharmaciststeve

Where VP picks stand on pharmaceutical costs

https://www.beckershospitalreview.com/pharmacy/where-vp-picks-stand-on-pharmaceutical-costs.html

JD Vance and Tim Walz, the Republican and Democratic candidates for vice president, respectively, have both voiced support for aspects of the Inflation Reduction Act, a landmark law that aims to lower prescription drug prices. 

Here are each candidate’s records on rising pharmaceutical costs, which are projected to increase 3.81% by summer 2025, according to Vizient. 

JD Vance

In a 2022 interview with AARP, the Ohio senator expressed support for giving Medicare the authority to negotiate prescription drug prices. That same year, President Joe Biden signed the Inflation Reduction Act, which grants CMS negotiation powers for a selective number of drugs with no generic or biosimilar competition. 

However, Mr. Vance has criticized the act’s allocation of at least $370 billion over a decade for incentives in wind, solar and other clean energy sources.

“It’s dumb, does nothing for the environment, and will make us all poorer,” he said in a 2022 post on X. 

Mr. Vance has also been vocal on addressing the opioid crisis. In 2016, he founded a charity to address the epidemic, though it shuttered within two years. 

Tim Walz

Two years before the Inflation Reduction Act passed — which he supported — the Minnesota governor signed the Minnesota Prescription Drug Price Transparency Act. The law requires drugmakers to report and provide reasons for significant price increases of prescription drugs to the state health department. 

In June, the state published its first list of 364 drugs from 76 manufacturers that are subject to this law.

Mr. Walz has also advocated for affordable insulin. In 2020, he signed the Alec Smith Insulin Affordability Act, which ensures eligible individuals in urgent need of the hormone can go to their pharmacy once in a 12-month period and receive a one-time, 30-day supply for a $35 copay. 

Since then, the nation’s largest insulin manufacturers have significantly lowered their prices to about $35 for a month’s supply.

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Retailers begin to roll out flu, RSV shot appointments

Posted on August 6, 2024 by Pharmaciststeve

The ideal time for a pt to get their flu shot is the last 2 weeks of Sept thru the first 2 weeks of Oct. Getting your flu shot during this time frame will help assure that the pt’s “blood titer” is as high as possible during what should be the peak flu season. Pts getting their flu shot this early when peak flu season comes around and/or it is a little later than normal. The chain pharmacists may start recommending that the pt get a second flu shot to boost their flu blood titers, to help protect the pt during the peak of the flu season. Of course, getting a booster will take ~ 2 weeks for the pt’s blood titer to peak again, and the protection that the pt has may be sub-therapeutic for 1+ weeks.

Retailers begin to roll out flu, RSV shot appointments

https://drugstorenews.com/retailers-begin-roll-out-flu-rsv-shot-appointments

Walgreens, Rite Aid and Bartell Drugs in the Pacific Northwest are just a few of the retailers who have begun offering the vaccines.

Retailers, including Walgreens and Rite Aid are ready for the upcoming respiratory virus season.

Walgreens is now offering flu shots for anyone aged 3 years old and older at stores nationwide ahead of respiratory illness season. Individuals and families can visit the pharmacy or schedule an appointment through the Walgreens, website or by telephone. 

In addition, the retailer shared that its trusted pharmacy teams are working to keep communities protected this upcoming respiratory season by helping to ensure everyone has convenient and timely options for vaccination, testing and treatment – all in one place.

Vaccinations: Flexible vaccination appointments are available – including nights, weekends and walk-ins – with the option to schedule additional vaccines in the same visit. Available vaccines include RSV, shingles, pneumococcal pneumonia and others. Walgreens also will provide the updated COVID-19 vaccine once available, recommended by the CDC to better protect against newer coronavirus variants.

Testing: Individuals who are experiencing a runny nose, cough or other respiratory symptoms should get tested to help ensure they can quickly take the necessary steps toward recovery. Walgreens offers a variety of convenient options for flu and COVID-19 testing, including over-the-counter, PCR and an easy “2 results in 1” in-store rapid test for COVID-19 and influenza A and B with results in 30 minutes, for $24.99.

Treatments: Walgreens offers a full range of over-the-counter and prescription medications to help individuals minimize symptoms and recover as soon as possible. In many states, Walgreens pharmacists can evaluate and prescribe antiviral medicine, including Paxlovid or Tamiflu, if an individual tests positive for flu or COVID-19. Walgreens also offers 1-hour delivery for medicine cabinet essentials and Same Day Rx Delivery for eligible prescriptions.

Data from the CDC and IQVIA show that patients are increasingly turning to pharmacies for their routine vaccinations. According to a 2023 IQVIA study, approximately 70% of adult flu vaccinations were administered in retail pharmacies during flu season, Walgreens noted.

“Pharmacies continue to be the cornerstone of healthcare in communities across the U.S. and patients rely on our trusted pharmacists for everyday care, and respiratory illness season is no different,” said Rick Gates, chief pharmacy officer at Walgreens. “Our pharmacists play a critical role in ensuring communities stay protected from viruses, providing accessible, quick and routine preventive services, including vaccinations, testing and treatment.”

More than 50,000 immunizing Walgreens pharmacy team members continue to play a critical role in helping to protect patients and their families from vaccine-preventable illnesses. Since 2010, they have administered more than 105 million vaccinations in communities throughout the United States. Thanks to their efforts, neighborhood pharmacies like Walgreens continue to be the most accessible destinations for care during fall respiratory virus season.

Rite Aid announced that appointments for flu and respiratory syncytial vaccines currently are available at all store locations, including Bartell Drugs in the Pacific Northwest. Customers can now schedule appointments effective immediately for these vaccines and many others to protect themselves and family members against the upcoming respiratory virus season through Rite Aid’s online scheduler.

“With school starting soon and the upcoming fall respiratory season just around the corner, it’s important for families to stay up to date on their routine vaccines and reduce the spread of respiratory illness,” said Karen Staniforth, chief pharmacy officer at Rite Aid. “Whether customers choose to walk-into the pharmacy or schedule their vaccine in advance, Rite Aid is here to provide convenient access to the health services they need.”

Rite Aid will be offering flu vaccines protecting against the strains of influenza that are expected to circulate in the U.S. this year, as well as a nasal spray flu vaccine, which is in limited supply at select locations as indicated by the scheduler. Customers receiving their flu shot until Sept. 30 will get a coupon for $5 off a $25 in-store purchase. This offer excludes stores in New York or New Jersey and some restrictions apply. 

The company noted that the 2024-2025 flu vaccines are recommended by the Centers for Disease Control for everyone six months of age and olde, and the RSV vaccine may be given at the same time as other vaccines, Rite Aid said.

Rite Aid and Bartell Drugs also offer COVID-19 and other routine vaccinations at all locations, helping customers and families stay up to date on vaccines that provide critical protection against certain diseases, some of which are required for certain ages, activities or for overseas travel. Rite Aid and Bartell Drugs will provide the new 2024-2025 CDC-recommended COVID-19 vaccine once available late this summer, which will better protect against the most prevalent COVID-19 strain. Rite Aid pharmacists can provide additional guidance on which vaccines are right for each customer and advise on the timing of administration of each vaccine.

Rite Aid and Bartell’s pharmacists can immunize adults and children three years of age and older against influenza and COVID-19. To schedule an appointment for a flu vaccine or other immunizations, Rite Aid customers can use the online scheduling tool, and some locations are accepting walk-ins. 

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Local Pharmacies Save Lives, While PBMs Don’t

Posted on August 2, 2024 by Pharmaciststeve

We had our independent pharmacy for 20 yrs, we were not in a rural area but a small city/county seat with ~ pop of 30,000.  One very memorial day – at least for me – I had a regular pt & wife come in. He wanted his blood pressure taken.  That was before “free-standing blood pressure units” where the pt takes their own blood pressure. It was before digital blood pressure cuffs. I took blood pressure with a BP cuff and a stethoscope.  As I listened to his heart rate it was very erratic and I asked him if his heart rate was always very erratic?  NOPE!. I suggested that he go over to the hospital/ED -<1 mile away. He claimed that he would go home first and then go to the hospital – I knew him very well, that he would not follow thru.  I called Barb out of her office and got her to take the fellow and his wife over to the hospital. He didn’t push back, he knew I was right. A couple of days later, his adult Daughter – also one of our pts – came in and thanked me for saving her Dad’s life. He had been admitted and put in the cardiac care unit and lived to be discharged and sent home. Beside the pharmacy we were a very large home medical equipment (HME) vendor. We normally had 200+ respiratory/oxygen pts – many were home-bound, enteral feeding pts (tube feeding), home IVs, etc, etc. We had a well-trained, experienced staff and I am sure that collectively, we had helped many pts and their QOL health issues. Many I was indirectly involved with. I wonder how these PBMs & mail order pharmacies are going to help pts with their QOL issues?

Local Pharmacies Save Lives, While PBMs Don’t

https://www.realclearmarkets.com/articles/2024/08/01/local_pharmacies_save_lives_while_pbms_dont_1048679.html

In a recent piece, “The FTC’s Villains du Jour are the Pharmacy Benefit Managers,” Ike Brannon of the Jack Kemp Foundation rushed to the defense of murky corporations who have earned near universal condemnation for their greedy, dishonest business practices. In Congress, where there is overwhelming bipartisan support for PBM reform, the House Oversight Committee recently released the findings of its year-long investigation of PBMs. Among its findings:

  • The three largest PBMs (CVS Caremark, Express Scripts, and OptumRx) “have used their position as middlemen and integration with health insurers, pharmacies, providers, and recently, manufacturers, to enact anticompetitive policies and protect their bottom line.”
  • While the PBMs often brag about how much money they’re saving for insurance plans and patients, “evidence indicates that these schemes often increase costs for patients and payers.”
  • The PBMs force drugmakers to pay “rebates” allowing their drugs to be covered by insurance, and that practice often prevents patients from getting lower-cost generic or biosimilar drugs.
  • “PBMs use their position as middlemen to steer patients to the pharmacies they own rather than pharmacies that may have closer proximity or provide better care.”

Those were just some highlights. Days before, the Federal Trade Commission issued an interim report as part of its years-long investigation of the PBMs. The FTC reviewed documents from the PBMs themselves (the PBMs are withholding many more) and found:

  • The merger of PBMs with insurance companies, retail chain pharmacies, and mail-order pharmacies has allowed the biggest three to control 80 percent of all prescriptions in the United States.
  • The big three PBMs exercise near total control over what drugs patients may have and which pharmacies they may use.
  • The big PBMs “appear to have the ability and incentive to prefer their own affiliated businesses, creating conflicts of interest that can disadvantage unaffiliated pharmacies and increase prescription drug costs.”

Sandwiched between these two scalding reports were blockbuster investigative pieces in the New York Times and Wall Street Journal that told the same story – one of market manipulation, self-dealing, and real-life patient suffering. In his piece, Mr. Brannon doesn’t address any of these findings directly. In fact, he seems to argue that monopolistic corporate middlemen are good for the system.

“Their (the PBMs’) most important task involves negotiating to reduce the costs of pricey prescription drugs, which they accomplish by using the market power they obtain from representing numerous healthcare plans. If a drug company refuses to provide a sufficient discount, a PBM’s clients may design their formularies so that there is a preference given for less expensive drugs,” he writes. But the FTC, the House Oversight Committee, and everyone else who’s investigated the PBMs find that the PBMs are doing precisely the opposite: They are negotiating for the most expensive drugs because the rebates are much bigger, and they’re keeping for themselves billions of dollars in rebates. The higher the cost of the prescription, the more money the PBM makes. Taxpayers and patients are paying more, so the PBMs can keep more.

Then, he says, “the notion that independent pharmacies are vital to the health of rural and small-town residents is also a big baffling.” Here he argues that it’s no big deal if millions of people lose their local pharmacy because PBMs are rigging the system, because mail-order drugs are better. Really?

In many rural and small-town communities, the local pharmacist is the only accessible healthcare provider. They don’t just dispense medicine. They counsel their patients, watch for dangerous drug interactions, package their medicines to maximize adherence, administer flu shots, COVID shots and other immunizations, monitor their blood pressure, help them control their diabetes, and perform mental health evaluations and many other healthcare services that mail-order pharmacies cannot deliver. Also, nearly all of them offer home delivery.

Local independent pharmacies save lives. PBMs don’t. Tragically, many local pharmacies are disappearing because of the PBMs and their indefensible greed. It’s a national crisis, and we applaud the FTC, leaders in both parties in Congress, the administration, and the many news outlets who are giving it the attention it deserves.

B. Douglas Hoey is CEO of the National Community Pharmacists Association, which represents more than 19,400 independent pharmacies across the country.

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ERISA requires Employers to find the lowest cost for HC – not the best outcomes

Posted on August 2, 2024 by Pharmaciststeve

Who put those requirements in place?  The LOWEST COST FOR HEALTHCARE WILL PROVIDE THE BEST PT OUTCOME?

Mark Cuban’s big warning for employers

https://www.beckerspayer.com/workforce/mark-cubans-big-warning-for-employers.html

Mark Cuban is issuing a big warning to self-insured employers: If your company receives pharmacy rebates through employee benefits, prepare for an eventual lawsuit.

“It’s not a question of if, it’s a question of when,” he wrote on X on July 22. “The inevitable class action suit will dwarf the tobacco settlements.”

Mr. Cuban’s comments come as large employers are beginning to face lawsuits from their workers over claims of mismanaging health and pharmaceutical benefits and violating their fiduciary duties under the Employee Retirement Income Security Act. 

ERISA requires self-funded employers acting as health plan fiduciaries to make an effort to find the lowest costs for healthcare services. In 2021, the Consolidated Appropriations Act amended ERISA to create new requirements for consultants and benefits brokers to disclose to employers any direct or indirect compensation they receive. Price transparency requirements enacted the same year also means that employers have gained more tools and are under more pressure to fulfill their obligations to employees.

“But unlike employers who hold a fiduciary responsibility, consultants and brokers do not hold a fiduciary relationship with employees, thus there is no obligation to prioritize the employer’s interest over their own,” researchers wrote in an AJMC study published July 19, and cited by Mr. Cuban.

“In light of recent legal action, employers may wish to better understand the financial incentives of their consultants and brokers when accepting their recommendations for rebate contracting strategies and pharmacy benefit design.”

In the most recent example, Wells Fargo was sued by employees in July for allegedly paying inflated prices to its contracted pharmacy benefits manager, Express Scripts. 

A February lawsuit against Johnson & Johnson accuses the company of paying inflated costs for generic prescription drugs designated as specialty medications to Express Scripts, thereby harming employees through higher costs, premiums, deductibles, copays and lower or limited wage growth. J&J’s employee health plan paid more than $10,000 for a 90-day prescription of a generic drug used to treat multiple sclerosis, which is available for as little as $40 without insurance at retail pharmacies, according to the suit.

“No prudent fiduciary would agree to make its plan and beneficiaries pay a price that is two-hundred-and-fifty times higher than the price available to any individual who just walks into a pharmacy and pays out-of-pocket,” the plaintiff’s attorneys wrote.

With employers increasingly feeling the pressure, some have sued their health plan and third-party administrators directly in an effort to access complete medical claims data. 

In June 2023, Kraft Heinz alleged Aetna used its role as third-party health plan administrator “to enrich itself to Kraft Heinz’s detriment” through undisclosed fees and processing medical and dental claims without human review. The food manufacturer voluntarily dismissed the lawsuit in December and moved it to private arbitration.

But employers can’t always point the finger at third-party administrators, Christin Deacon, an attorney and principal owner at VerSan Consulting, previously told Becker’s. For example, if an employer signed a bad contract that allowed egregious behavior, the TPA could turn around and ask why the employer didn’t act upon that. 

“I think that definitely plays into the fear factor of employers not being more aggressive,” Ms. Deacon said. “There’s plenty out there that are going to get on the bandwagon of being more aggressive with their carriers. Nobody wants to be the first, but everybody wants to be a fast follower.”

“I think the first step is get a handle on all of your existing contracts and relationships and ask for your claims data. Document everything you’re doing to try to be a good fiduciary to the plan,” Ms. Deacon said. “Get your contracts, read your contracts, get your data and put processes in place that are going to help you protect yourself again from that fiduciary liability.”

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