(This information concerns those who enrolled into Individual and Family Health Plans through the Government Exchange – Covered California – and received a Subsidy or APTC. It does NOT concern you if you are either on an Employer-Sponsored Group Health Plan or a Medicare Health Plan. This information pertains only to California and may not apply to other states.)
As a courtesy, we are passing this information onto you. |
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Covered California – Urgent Last Minute Alert
Blue Shield of California Plans to Shut Down for 1 Week in September to Save on Payroll Due to Obamacare Losses
http://www.bizjournals.com/sanfrancisco/news/2016/08/11/exclusive-losses-blue-shield-california.html
As reported by the San Francisco Business Journal, Blue Shield of California will be closed from September 3 to September 12 while its employees take the week of Labor Day off. Although Blue Shield announced there will be some customer service staff working that week we assume the phone lines will be jammed for the entire week.
It appears that Individual, Small Group and Medicare departments are affected by the shutdown.
We do not yet know whether the Blue Shield member portal, broker portal or employer portal will be accessible and will reflect current information during the shutdown.
ALL APPLICATIONS FOR BLUE SHIELD PLANS SHOULD BE SUBMITTED AS SOON AS POSSIBLE SO THEY CAN BE PROCESSED WITH AN ID NUMBER ISSUED BY FRIDAY, SEPTEMBER 2. APPLICATIONS ARE CURRENTLY TAKING 10-14 DAYS TO BE PROCESSED.
This is an unprecedented announcement by an insurance company. We will do our best to provide service to our clients during this shutdown, but if Blue Shield is closed our ability to provide customer service will also be severely impacted.
(NOTE: This information relates only to Blue Shield of California, a taxpaying non-profit insurance carrier that operates only in California. Please do not confuse this company with Anthem Blue Cross, or any other Blue Cross or Blue Shield organization in states outside of CA.)
Phil Lee
Lee Health Insurance Services (BLIS Corporation)
925-284-2000
How One Pharmaceutical Company Priced Its Drug
I want to share with you the following WSJ article detailing how one major pharmaceutical company took advantage of the health care system to enrich itself, its shareholders and Wall Street with drug prices that produce “99% gross profit margins”.
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.”
Last Chance to Enroll into a Health Plan in 2015
(This information relates only to Individual and Family Health Plans, not Medicare or Group plans)
If you are uninsured and do not have a special Qualifying Event, Thursday April 30th is the last day that you may enroll into an Individual Health Plan using the Govt.’s special extension by claiming that you are unaware of the uninsured penalty.
If you apply by April 30th, you will receive a June 1st effective date. Otherwise, you will have to wait until the end of the year.
In order to apply for coverage during this extended enrollment period to a plan either On or Off the Covered California health exchange, most carriers require you to do so through a certified agent. Anthem Blue Cross further requires the application to be on paper through an agent.
At Lee Health Insurance Services we 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 whomever you get them from. If you qualify, you will receive the tax subsidies that you are eligible for based on your household income.
Phil Lee
Lee Health Insurance Services
800-286-7445
www.health-insurance.com
Fixing Obamacare at Capitol Hill
Last week, I and my fellow board members from our agents and brokers’ Association of Health Underwriters (AHU) gathered at Capitol Hill in Washington, D.C. to visit with Congressmen and women from both sides of the aisle to discuss issues and challenges that affect health insurance for Americans. During the past 18 months since the ACA rollout, agents and brokers exceeded everyone’s expectations by excelling in their jobs, while the Govt. Exchanges and all other entities fell below expectations. Our association has received the recognition of lawmakers and regulators, and we strive to promote a system that would be more affordable, equitable, less bureaucratic to consumers and employers, while offering more choice and competition, and reducing the burden on taxpayers.
Thank you for your feedback and concerns which I incorporated into our conversations with legislators.
Phil Lee
Lee Health Insurance Services
www.health-insurance.com
800-286-7445
Obamacare: Enroll by Sunday 2/15 or Pay a Penalty
(Please disregard this if you have an Employer Group plan or have Medicare.)
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
Alert to Individuals who Received Tax Subsidies or APTC to Pay for Covered California Health Plans – Form 1095A
(Note: This alert relates only to Individual and Family health plans. It does not relate to Employers with group health plans, nor to Seniors with Medicare plans.)
Re: IRS Form 1095A and Form 8962
Covered California, the California health insurance exchange, will shortly be sending out a form called the IRS Form 1095A to all individuals and families who received tax subsidies in 2014 to help pay for their Individual/Family health plans. This is required by the federal ACA law (Obamacare) and will be sent out by Jan. 31st.
These forms will show, in detail, by month, the amount of APTC (Advance Premium Tax Credit or Tax Subsidy) that the recipient received in helping pay the premium for their subsidized health plans in 2014.
These individuals will be required to use this Form 1095-A to obtain information needed to complete Form 8962 (Premium Tax Credit (PTC)). They must then complete IRS Form 8962 and file it with their 2014 Tax Return by April 15.
Those who enrolled into Off-Exchange health plans need not be concerned, since they did not receive any tax credit, you will not receive a 1095A. Only those who applied for a health plan through Covered CA AND who received an APTC to reduce the premium paid, will be receiving these 1095A forms.
Those enrolled into Medi-Cal (California Medicaid), those on Medicare, and those enrolled on employer group plans are not affected by the above.
Disclaimer: We are not qualified to give tax advice. If you have any questions concerning either Form 1095A or Form 8962, please contact Covered CA, your tax adviser, the IRS or go to the IRS website links below:
www.irs.gov/uac/About-Form-1095-A
www.irs.gov/uac/About-Form-8962
Philip W Lee, MBA
Lee Health Insurance Services
www.health-insurance.com
800-286-7445
Update on Enrollment Deadlines: Extensions for OFF Exchange Plans
(Note: This alert relates only to Individual and Family health plans. It does not relate to Employers with group health plans, nor to Seniors with Medicare plans.)
ON Exchange (Covered CA) plans:
As reported earlier, the 12/15/14 deadline has been extended to midnight Sunday 12/21/14. Online applications only. This applies to all Covered CA Exchange plans from Anthem Blue Cross, Blue Shield and Kaiser.
OFF Exchange plans (outside of Covered CA and direct with insurers):
Anthem: The deadline has been extended to midnight Sunday 12/21/14. Applications must be on paper.
Blue Shield: There are no extensions. The deadline passed on 12/15. (If you still want Blue Shield but do not need a subsidy, you may still apply through the Covered CA portal. But you will still have to provide income and immigration status to the Govt.)
Cigna: The deadline has been extended to Friday 12/19/14 at 5 pm PST.
Health Net: The deadline has been extended to midnight Sunday 12/21. Online applications only. Applicants are encouraged to pay their initial premium by 1/1/2015, without waiting for their NOA (Notice of Acceptance). You may use HN’s 24-hour payment line at 1-800-539-4193. You will hear the amount due as soon as HN has your enrollment in their system.
In all cases, the application extension plus the time required to process the files will impact timely receipt of the NOA (Notice of Acceptance) letters, initial premium bills, delivery of ID cards and policy descriptions.
If you need help, please call us at 925-284-2000 or email [email protected].
Phil Lee
800-286-7445
Last Minute Alert: Covered CA Deadline Extended to Dec. 21 for Individual Health Plan Enrollments
(Note: This alert relates only to Individual and Family health plans. It does not relate to Employers with group health plans, nor to Seniors with Medicare plans.)
We just learned tonight that Covered CA, the State Health Exchange, has extended the previous deadline for Jan. 1 enrollments, from Monday Dec. 15th to Sunday Dec. 21st at midnight. This extension applies only to Individual plans, and only to Consumer and Agent-assisted enrollments.
Covered CA also states that enrollments completed after Dec. 15th may see delays in invoicing as well as delays in proof of enrollment procedures. To facilitate faster enrollment, they encourage submitting applications as soon as possible, but no later than Dec. 21st.
Please call us, Lee Health Insurance Services, at 925-284-2000, if we can be of assistance.
Phil
Philip W Lee MBA
Lee Health Insurance Services, BLIS Corporation
800-286-7445