The Phia Group Blog Posts

IDR: The Confusion Never Ends!

On April 8, 2024
It seems like every day that The Phia Group's consulting team is presented with an IDR-related issue brought up by either a provider in an appeal or simply a TPA trying to iron out or streamline its processes. Sometimes the question centers around the specifics of the IDR process, but sometimes the question instead focuses on the very concept of IDR itself and when it becomes applicable to begin with.

The Phia Group Is Named Winner of the 2024 Top Workplaces USA Award

On April 3, 2024
Canton, MA – The Phia Group, a leading provider of health care cost containment solutions, proudly announced today that it has been honored with the 2024 Top Workplaces USA award. This prestigious recognition, presented by Energage, underscores The Phia Group's commitment to fostering an exceptional workplace environment for its employees by providing such outstanding benefits as ongoing education, philanthropic events, and zero-cost health coverage for employees that have been with the company for five or more years.

Lenmeldy: The World’s New Most Expensive Drug

On April 1, 2024
The U.S. Food and Drug Administration (FDA) stoked the fire that is the ever-present discussion surrounding gene therapy when it approved Lenmeldy on March 18, 2024. Lenmeldy is the first FDA- approved gene therapy to treat metachromatic leukodystrophy (MLD), a rare disease that affects the brains and nervous systems of children in their late infantile and early juvenile years.

The Phia Group Announces the Addition of the Renowned John Blaney as Their Chief Innovation Officer

On March 28, 2024
Canton, MA – Rarely can an organization with decades of industry leading ascendency truly claim to make a change that will both revolutionize its fundamental essence to the core, as well as deliver to its clients monumental improvements on top of what is already the industry’s best results. In other words, when does the best get even better? This is one such moment. March 30, 2024 will be remembered as the day that The Phia Group publicly announced the addition of the renown John Blaney as their Chief Innovation Officer.

Empowering Plans: P186 – Xenotransplantation: A Potential Game Changer for Self-Funded Plans

On March 28, 2024
Ham it up with attorneys Nick Bonds and Jen McCormick from the Phia Group as they dive into the groundbreaking world's first successful genetically engineered pig kidney transplant at MGH in Boston. Explore the details of this medical breakthrough, its implications for the healthcare industry, and the considerations for the future of dialysis, plan language, and stop loss provisions. Tune in to gain invaluable insights into the intersection of law, healthcare, and cutting-edge medical advancements.

Wegovy: Not Just a Weight Loss Drug

On March 20, 2024
Earlier this month, the wildly popular weight loss medication was approved in the US to help prevent life-jeopardizing cardiovascular events in people who are overweight, obese, and/or have a history of cardiovascular disease. The FDA’s stamp of approval for drugmaker Novo Nordisk to include cardiovascular benefits to Wegovy’s label meant it was the first weight loss drug to market itself in this manner. Now the million-dollar question (no pun, intended) becomes, will this label expansion make insurers feel more inclined to provide coverage? For good measure, will Medicare, currently barred by law from covering drugs for weight loss alone, be compelled to include Wegovy under its umbrella?

Empowering Plans: P185 – Weighing the Options

On March 14, 2024
Over the last twelve months we have seen major interest in GLP-1s (Semaglutide- Ozempic / Wegovy and Tirzepatide – Mounjaro / Zepbound). Although GLP-1s have been around for years as a treatment for diabetes, the recent popularity is due to their use as a weight loss drug. Join Ron Peck and Corey Crigger as they discuss the impact this surge in demand has had on health plans and consumers. Are health plans and consumers informed about the benefits and drawbacks of this drug? Are consumers too focused on the benefits? Are health plans too focused on cost? Find out as Ron and Corey discuss one of the hottest topics in the industry.

The Indirect (But Significant) Impact of a Recent Massive Healthcare Breach on Benefit Plans

On March 11, 2024
It’s not often we see a healthcare/health benefit story so big that it crosses into the mainstream. The recent cyberattack in the healthcare industry is just that type of story, however, and the American Hospital Association has already called it “the most significant cyberattack on the U.S. health care system in American history.”

Empowering Plans: P184 – State of the Union, 2024

On March 8, 2024
In his third State of the Union address, President Biden touted his administration’s record and outlined the issues he and his team will likely be campaigning on heavily as the 2024 presidential race kicks off in earnest. Sprinkled throughout were a number of policy wish list items, including some key healthcare initiatives that we’ll be keeping a close eye on in the coming months. Attorneys Brady Bizarro and Nick Bonds bring you some of the highlights in this episode of the Empowering Plans podcast.

How the Recent Industry Cyberattack Impacts You

On March 7, 2024
Late last month, an apparent massive cybersecurity incident involving the potential theft of patient data – this could entail personally identifiable information, sensitive health information, and financial information -- and encrypted company files seemingly paralyzed one of the nation’s largest pipelines for healthcare payments and prior authorization processing. Impacting a substantial percent of Americans’ medical claims (billions of claims totaling over a trillion dollars per year), millions have been affected. But perhaps the worst part is that many don’t even know it – and won’t be aware until they need to visit their physician or refill a prescription and face new hurdles in getting their customary treatment.

Empowering Plans: P183 – The Therapeutic Equivalence Approach: A New “Pill”ar of Contraceptive Coverage

On February 29, 2024
The DOL recently issued new guidance on the long-standing contraceptive coverage mandate, and this time they took a different approach. Instead of clarifying prior guidance or issuing novel interpretations of the law, the DOL is giving health plans an alternative way to comply with the contraceptive coverage mandate: either follow the prior guidance issued in 2022… or don’t! The DOL introduced the “therapeutic equivalence” approach, whereby plans can comply with the law in a different, potentially less-burdensome way. Join The Phia Group’s Kendall Jackson and Jon Jablon as they discuss this “therapeutic equivalence” approach to compliance, what it means for consumers, and what it means for health plans.

The Skinny on Weight Loss Drugs

On February 21, 2024
From Contrave to Saxenda to Wegovy and beyond, society is being bombarded with messaging about weight loss drugs. While many publicly debate their efficacy and long term viability, far fewer are openly asking who will pay for them – and how. For those of us that sponsor and service health benefit plans, the costs arising from this trend are very real. While we want to help people lose weight, get fit, and improve their overall health – the best way to approach this matter is still uncertain. Join The Phia Group for another free webinar! Our team will discuss this very relevant topic, including related issues such as off-label drug usage, international drug importation, defining medical necessity, plan drafting and exclusions. Likewise, the importance of educating plan membership about the costs of healthcare, and what it means to be self-funded.

Phia Group

Phia Group Media