I received the following email from Anthem to agents and brokers last week with details about this decision. Please click on the link below:
Please review the following to be sure that you will actually be affected by this:
We might be able to help you find alternatives as soon as the insurance carriers such as Blue Shield, Health Net and Kaiser release their new rates for Jan. 1, in either September or October.
Phil Lee
Lee Health Insurance Services (BLIS Corporation)
925-284-2000
]]>The Senate Appropriations committee’s own budget analyst has estimated the cost to be $400 billion for just the first year, which is over twice the entire California State budget of $180 billion. SB 562’s sponsors have no clear plan for paying for single payer but have suggested new employer and employee taxes and income tax increases. These taxes would be in addition to current Federal, State, local, municipal and property taxes that Californians pay.
Please see this press release from the California Association of Health Underwriters for more information.
https://bliscorp.egnyte.com/dl/6kk5OkKcvK
I was present in the Senate Chambers when this bill passed the Health Committee with a 5-2 party-line vote on April 26th. I was again present when the Appropriations Committee debated this bill on May 22nd. But despite serious concerns raised by many of the committee members the bill passed with a 5-2 party-line vote. It will now be voted on this week by the full Senate.
TO TAKE ACTION:
If you object to losing your right to Medicare, losing your employer plan, paying more taxes, losing your right to choose your doctor, your hospital and your insurance benefits please contact your State Senator to let him/her know. Click on the link below to find your State Senator and his/her contact information. Then click on the name to reach their website to communicate your message: http://findyourrep.legislature.ca.gov/
For your convenience, this is a letter template suitable for sending to your district Senator if you so choose:
https://bliscorp.egnyte.com/dl/9IOEU956MF
Phil Lee
925-284-2000
]]>SB 562 is very bad for you, your family and the future of the State of California for many reasons:
CALL TO ACTION:
If you object to losing your right to Medicare, losing your employer plan, being taxed an additional $9,200 per family member, losing your right to choose your doctor, your hospital and your insurance benefits, then please contact your State Senator to let him/her know. Click on the link below to find your State Senator and his/her contact information. Then click on the name to reach their website to communicate your message: http://findyourrep.legislature.ca.gov/
Just say No On SB 562 to preserve your choice in health care and to keep California from declining into certain economic ruin. Thank you for taking the time to read this email.
]]>As a courtesy, we are passing this information onto you.
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I hope this will give you with some insight into the behind-the-scenes forces that are driving up health care costs.
How One Pharmaceutical Company Priced Its Drug
Phil Lee
Lee Health Insurance Services (BLIS Corporation)
925-284-2000
www.linkedin.com/in/philwlee www.yelp.com/biz/lee-insurance-services-lafayette-7Affordable
Wall Street Journal 5/2/2016:
Valeant’s CEO Was Key Force on Pricing
Documents collected during a Senate investigation provide look at how Valeant arrived at sharp price increases
Michael Pearson, chief executive officer of Valeant, lobbied for aggressive price increases on acquired drugs in recent years. PHOTO: DREW ANGERER/BLOOMBERG NEWS
By JACQUIE MCNISH and LIZ HOFFMAN
Updated May 2, 2016 10:33 a.m. ET
In early 2015, when Valeant Pharmaceuticals International Inc.’s top brass met to set prices on a soon-to-be-acquired cardiac drug, some executives suggested slow, staggered price increases. Chief Executive Michael Pearson disagreed.
To reach Valeant’s internal profit targets, Mr. Pearson lobbied for a single, sharp increase. Hospitals could still make a profit at the higher price, he argued, which meant patients would still have access to the drug. The team deferred. The day it completed its February 2015 purchase of the drug, called Nitropress, Valeant tripled the cost.
The exchange, recounted in a document reviewed by The Wall Street Journal, shows in greater detail than was previously known how Valeant and its now-outgoing CEO Mr. Pearson pursued quick, aggressive price increases on acquired drugs in recent years—a strategy that sparked widespread backlash and landed Mr. Pearson in front of a Senate investigative panel last week.
A spokeswoman for Valeant, Laurie Little, said, “We heard very clearly the concerns raised by the Senate Special Committee on Aging, and the board is working to map out a new path for the company going forward. That will include consideration both of how best to set drug prices and of the appropriate role of patient assistance programs in helping to ensure that patients can obtain the drugs that doctors prescribe for them.”
At last week’s Senate committee hearing Mr. Pearson said Valeant was “too aggressive” with drug price increases.
Dozens of documents collected during the Senate investigation provide a deeper look at how Valeant arrived at sharp price hikes on some of the drugs it sells. The documents underscore the challenges Valeant faces now that it has promised to roll back some prices and rely less on acquisitions for which price increases are a major driver. That pivot has investors and analysts concerned about where Valeant’s profits will come from and how it will service the $30 billion in debt it carries.
Related Video
Valeant CEO Michael Pearson testified at a Senate hearing investigating drug pricing Wednesday that he and the company made mistakes and “Valeant was too aggressive.” Watch an excerpt of his testimony. Photo: AP
Concerns over the company’s reliance on price increases, its accounting and other business practices hammered Valeant stock, which has fallen more than 85% since its high last summer. Valeant has said it is comfortable with its liquidity.
William Ackman, a major Valeant shareholder and recently appointed director, told the Senate committee that he and other new directors have “stabilized” a company that has made “significant mistakes.” The company’s stock has gone up about 27% over the past month as the company filed a long-overdue annual report, hired a new CEO and reached an agreement with lenders to avoid a technical default.
Under Mr. Pearson, a former McKinsey & Co. consultant, Valeant earned a loyal following on Wall Street for its profitable strategy of buying existing drugs with price-increase potential rather than developing them in-house. “Bet on management, not on science,” he often said. While Valeant did have a research program, Mr. Pearson said that most of Valeant’s R&D products are reformulations of existing drugs, such as a new delivery method for a glaucoma medicine, according to the Senate documents.
Valeant’s pattern of price increases, including on Nitropress, was the subject of a page-one story by the Journal last year. That strategy drew criticism amid broader political scrutiny of pharmaceutical costs. The Senate panel last week—the third in a series of hearings on drug pricing—focused on four Valeant drugs in particular, including Nitropress and Isuprel, which Valeant acquired from Marathon Pharmaceuticals in February 2015.
The other two drugs, Cuprimine and Syprine, are used to treat Wilson’s disease, a rare ailment involving a buildup of copper in the body, and were acquired by Valeant in 2013. Months after it raised the price of the cardiac-care drugs in 2015, Valeant sharply raised its price tags on Cuprimine and Syprine.
The price of Cuprimine has risen 5,787% to $26,189 since 2013, with most of the increase occurring in the summer of 2015, according to an analysis prepared by Senate committee staff for the hearing. The cost of Syprine jumped 2,934% to $19,783 during the same period. A doctor testified at last week’s Senate hearing that a liver transplant, an alternative treatment for Wilson’s disease, is now cheaper than a lifetime of Valeant drugs.
The Senate analysis referred to wholesale acquisition costs that hospitals and other purchasers pay for drugs.
Although the four drugs made up only a fraction of Valeant’s $10.3 billion in 2015 sales, they ranked among Valeant’s 30 most profitable drugs as measured by net profit, Valeant Chief Financial Officer Robert Rosiello told the Senate committee last month in a written response to questions.
So valuable were Syprine and Cuprimine that when a senior Valeant official learned that Valeant’s customer-service group lacked a way to log inquiries from patients complaining about their rising costs, he wrote in an email that “for these…drugs we need to find a way asap.” He inquired about purchasing software to track their complaints. “These patients are too valuable to lose,” Laizer Kornwasser a former Valeant executive vice president, wrote, according to the Senate hearing documents.
Mr. Kornwasser didn’t immediately respond to requests for comment.
At the 2015 meeting on Nitropress, which was attended by Valeant’s then-finance chief,Howard Schiller, Mr. Kornwasser and other top executives, some of the executives recommended gradual price increases to avoid alienating core hospital buyers of the drug, the Senate documents show. Mr. Pearson argued it wasn’t an “exorbitant” price for a drug that saved lives and represented only a fraction of hospital costs, according to the documents.
Upon completing its purchase of the two drugs in February, Valeant sharply raised the price of both Isuprel and Nitropress.
A month later, when a Deloitte consultant studied further price-tag spikes on the two drugs, the consultant asked a senior Valeant executive in an email: “Are you ok with the above assumptions? They are leading to high gross margins (more than 99%).”
The Valeant executive replied in an email that the analysis “looks right, and I’m not surprised they are extremely profitable.”
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The year-end Open Enrollment Period for Individual Health Plans ended on January 31, 2016. However, certain individuals may still be able to apply for a health plan in 2016. This special circumstance is called the Special Enrollment Period (SEP). You need to have a Qualifying Event (QE) to qualify. Here’s what you need to know.
You can buy health coverage outside of the open enrollment period when you have a qualifying life event—through a special enrollment period (SEP). Most SEPs last 60 days from the date of the qualifying life event.
Qualifying life events for a SEP include:
Please note that voluntarily terminating other health coverage or being terminated for not paying premiums is not considered a qualifying event.
All insurance companies will require written proof that you have an acceptable qualifying event. When enrolling during an SEP, please make sure to include qualifying events verification documents in the application.
This is a link to Blue Shield of California’s interpretation of the ACA laws regarding SEP and QE’s. Different carriers may have slightly different interpretations and requirements.
https://bliscorp.egnyte.com/dl/QJhtXag1KT
Phil Lee
Lee Health Insurance Services (BLIS Corporation)
925-284-2000
www.linkedin.com/in/philwlee www.yelp.com/biz/lee-insurance-services-lafayette-7Affordable
]]>
Re: Premium Reimbursement by Employers (outside of an ACA-Approved Group Health Plan) is a Costly Violation
Starting on July 1st, the IRS will begin assessing a penalty of $100 a day (per employee for each affected employee) to employers who continue to pay for employees’ individual health plans. Please click below link to this article.
We would be happy to help your company find affordable solutions to comply with local and federal requirements regarding health insurance.
Phil Lee
Lee Health Insurance Services
800-286-7445
For those of you who are still uninsured or who just found out from doing your 2014 tax return that you have to pay a penalty, there is still time to enroll. If you are currently uninsured and can testify that you were not aware of the penalty, you may still enroll. However, there’s not much time left. The deadlines are:
April 15th, for a May 1st Effective Date.
April 30th for a June 1st Effective Date.
In order to apply for coverage during this extended enrollment period to a plan either On or Off the Covered California health exchange, you must do so through a certified agent or broker. We at Lee Health Insurance Services (800-286-7445) would be happy to serve as your agent. As always, there are no costs, no fees for our services. The premium rates you pay are the same approved and regulated rates whoever you get them from. If you qualify, you will receive the tax subsidies that you are eligible for based on your household income.
Covered California Application Problems
We are finding that many of you trying to enroll onto Covered California online got stuck or sent off to MediCal (Medicaid). E.g. if you happen to put an Employment End Date, you would likely be sent to MediCal.
We, at Lee Health Insurance Services, have figured out the “fixes” to these issues, and would be delighted to help you resolve them in order to secure coverage from Covered California.
Very sincerely,
Phil Lee
Philip W Lee MBA
Lee Health Insurance Services
Employee Benefits and Health Insurance
800-286-7445
www.Health-Insurance.com
Phil Lee
Lee Health Insurance Services
www.health-insurance.com
800-286-7445
For those of you who have not already enrolled into an Individual health plan, the enrollment deadline is this Sunday Feb. 15th.
After the Feb. 15th deadline, you will have to wait until the end of the year to enroll for Jan. 1, 2016. If you are uninsured, you may also face a penalty when you file your tax return in April 2016.
Possible Extension:
For those of you applying through Covered California for an On-Exchange health plan, if you start an online application before 2/15 but are not able to complete it on that day, we, as agents, have been given an extension to help you complete it, by 2/24. This extension is not available to the public and does not apply if you do not start an application by 2/15.
If you need help, please call us at 925-284-2000 or email [email protected] .
Phil Lee
Lee Health Insurance Services
925-284-2000
www.health-insurance.com