Phia Group

Empowering the 2023 SIIA National Conference

On October 26, 2023
Earlier this month, the self-insurance industry’s most prominent thought-leaders, innovative service providers, and esteemed subject matter experts convened at the 2023 Self-Insurance Institute of America (SIIA) National Conference at the JW Marriott Phoenix Desert Ridge Resort & Spa. The SIIA National Conference, which this year covered such pressing topics as artificial intelligence, surprise billing, emerging trends impacting the employer stop-loss market, and recent legislative and regulatory updates, is widely considered to be the self-insurance industry’s annual marquee event, bringing together hundreds of industry professionals including TPAs, vendors (there were over 950 booths representing industry vendors stationed in the exhibitor hall), brokers, captive managers, stop-loss carriers, and solution providers.

The Phia Group's 4th Quarter 2023 Newsletter

On October 24, 2023
The Phia Group is off to a great start in the fourth quarter of 2023! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

The Stacks – 4th Quarter 2023 Newsletter

On October 24, 2023
This is "The Stacks" from The Phia Group's 4th Quarter 2023 Newsletter

Cell and Gene Therapy: Industry and Claim Cost Impact

On October 18, 2023
Drugs are on our mind! In our industry, they are what can make or break the bank. Is this an episode of Breaking Bad? No – It’s American healthcare. From specialty drugs and gene therapy to pharmacogenomics and international drug importation, prices aren’t the only thing getting high. Join The Phia Group’s innovators as they discuss frightening trends in drug costs, define the risks and present solutions you can implement today.

Empowering Plans: P173 – Gene-y in a Bottle: A Magical Overview of Cell and Gene Therapy

On October 12, 2023
Your wish is our command! Join Ron Peck and Corey Crigger as they discuss how this emerging treatment can impact self-funded health plans. With prices as high as $3.5 million, you can’t just wish for a strategy for dealing with these therapies, you must plan for it. Ron and Corey discuss the motivations to cover, the future benefits, and the concerns they are hearing from clients. You don’t know what we can see, so join us on a magic carpet ride around this life saving, but costly treatment.

District Court Strikes a Blow to Copay Accumulator Programs

On October 11, 2023
Many of our clients are aware of, or even utilize, “copay accumulator” programs – these programs create plan savings by not counting amounts received by patients from manufacturer assistance programs toward annual deductibles and out-of-pocket maximums. Some programs go a step further by actually increasing the applicable copayment for certain drugs to maximize the amount a patient may be eligible to receive from manufacturers.

Choking on the Gag Clause

On October 4, 2023
Whether you’re a health plan, TPA, broker, or anyone else, join The Phia Group’s consulting team leaders as they gather to discuss the prohibition on gag clauses, best practices, and next steps to ensure a gag-free tomorrow!

Empowering Plans: P172 – Navigating the Gag Clause Prohibition

On September 28, 2023
In this installment of The Phia Group’s Empowering Plans podcast, attorneys Jon Jablon and Kendall Jackson delve into the issue of the gag clause prohibition, a mysterious law that continues to confound the self-funded industry. With the first attestation requirement approaching at the end of 2023, now is the time to make sure you know what needs to be done, how to do it, and how to keep yourself safe and compliant.

Fall Is Here & So Are the Cold-Weather Germs – New CDC Recommendations

On September 26, 2023
Fall is officially here as the fall equinox has passed and with fall comes the impending “flu season” which also brings a bunch of other germs – new strains of COVID-19 and a rise in RSV cases. If you have children who have headed back to school (even college kids), you’ve probably noticed an uptick in stuffy noses and tummy aches already.

Three Shots for Autumn

On September 18, 2023
It’s a daunting Venn diagram – the interplay of three potentially fatal diseases: Respiratory Syncytial Virus (“RSV”), COVID-19, and influenza. And with summer slipping into fall, this triple-headed monster is (once again) threatening to rear its ugly head. But, thanks to modern medicine, could this cold-weather season have a less devastating toll on humanity than what transpired a year ago?

Empowering Plans: P171 – Mass Torts 101

On September 15, 2023
From time to time, do you hear about mass torts in the news but feel like you could use a little more background knowledge? Look no further than the latest edition of the Empowering Plans podcast series, (“Mass Torts 101”) in which attorneys Cindy Merrell and Lisa Hill explain the difference between the two types of mass tort cases -- class action and multidistrict litigation (MDL) – while delving into a couple of the larger MDLs making news of late.

Empowering Plans: P170 – PSA on the NSA

On August 31, 2023
It’s 10’o clock, do you know where your IDR determinations are? Join Attorneys Brian O’Hara and Corey Crigger as they issue a public service announcement on the state of the No Surprises Act, and specifically the challenges with the IDR process. Friends don’t let friends miss this podcast! In addition to the PSA on NSA, Corey discusses a case study highlighting the benefits of the Safeguard Program. Just Say No to skipping this episode of Empowering Plans.

The First Ten: The Initial Round of Drugs Subject to Medicare Price Negotiations

On August 30, 2023
On August 29, President Biden unveiled the first ten prescription drugs that will be subject to price negotiation with Medicare (Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, Fiasp and NovoLog), representing a watershed moment for Democrats who have spent years clamoring for lower prescription costs.

Protecting the Most Vulnerable

On August 24, 2023
In February 2022, we received a balance bill referral that was truly exceptional, but for all the wrong reasons. Our client received a staggering bill of over $675,000.00 after a premature delivery with major complications resulted in a two-month stay in the NICU. It was an unjust financial burden exacerbating an already challenging situation.

Wegovy: The Heart of the Matter

On August 18, 2023
Obesity adversely impacts upwards of 100 million adults in the US and accounts for nearly $150 billion in annual health care spending, yet health insurers have been reluctant to cover high-priced weight loss drugs, ones they frequently label as “cosmetic” or “lifestyle” medications. But, given what transpired earlier this month, is it possible that there could be an impending sea change in the medical field’s perception of such treatment?