Copay Accumulator: An Emerging Drug Benefit Problem

Earlier this month, the AIDS Institute joined with 60 HIV organizations that sent letters to state attorneys general and insurance commissioners nationwide asking them to investigate copay accumulators, a new drug copay practice that’s emerged in employer and marketplace plans. It’s something that’s not just impacting the HIV population, either. In fact, any patient taking an expensive drug that’s partially funded through a drug company’s copay assistance program should beware. At issue is a change that means insurers may no longer count copay assistance payments toward a patient’s annual pharmacy deductible. To add to the drama, many patients only find out about the change when they get a huge bill midway through the plan year, reports Kaiser Health News’ Michelle Andrews.


Covered Cal Reminds College Graduates About Special Enrollment
Somebody is on the ball at Covered California. Their latest effort to enroll more eligible Californians is nothing short of impressive. Covered California has reached out to commencement speakers from across the state to encourage them to weave the importance of health insurance into their remarks.  Among those who have agreed to participate are commencement speakers at California State University – Los Angeles, the University of California at Irvine and the University of California at Merced. In addition, Cástulo de la Rocha, president and CEO of AltaMed Health Services, and Dr. Kenneth Kizer, director of the Institute for Population Health Improvement at the University of California, Davis and the former director California’s Department of Health Services, co-authored an op-ed urging students who may find themselves without coverage after graduation to seek solutions. The op-ed was sent to 96 college newspapers throughout the state. Californians may enroll during Covered California’s special-enrollment period if they have a qualifying life event, like losing their coverage. For example, students who had their health care needs provided by their school and are losing that coverage upon  graduation, or who will lose coverage through their parents’ plan when they turn 26, are eligible to sign up for a new plan through Covered California.


The Case for An HSA-First Investment Strategy
Josh Collins, writing for EBN today makes this argument: “Conventional wisdom suggests that employees owning an HSA and retirement account, such as a 401(k) or IRA, should first contribute to their retirement accounts, and then max out their HSA contributions through payroll deductions. While this is an attractive strategy, an even better one is for employees to first max out HSA contributions regardless of their tax bracket, and contribute to their traditional retirement plans afterwards.” Read the whole post here.


Too Many Americans Not Accessing Dental Care
According to a recent national survey from Delta Dental, many adults don’t seek out proactive dental care and confess to visiting the dentist less often than they should. As a result, many adults suffer from oral health emergencies. The study reveals that more than half of Americans (57 percent) have made an unplanned visit to the dentist, with pain in mouth (33 percent) being cited as the leading cause. According to the Adult’s Oral Health & Well-Being Survey, a chipped or cracked tooth (26 percent) or a cavity (20 percent) also ranked as top reasons for Americans to suddenly find themselves in a dental chair. A lost crown or filling tied at 14 percent. Capping off the key reasons is bleeding gums (8 percent). The Delta Dental survey indicates that more than two in five (42 percent) Americans admit they typically visit a dentist less than once a year. Want more dental info? Don’t miss Cal Broker’s July, where we’ll do a deep dive into dental.


MassMutual Introduces New Target Date Fund Family
It makes perfect sense: the MassMutual Retirement Savings Risk Study found that nine in 10 retirees (94 percent) and pre-retirees (92 percent) “strongly agree” or “somewhat agree” that it is important to take steps to avoid major stock market losses right before retirement. And one in two pre-retirees (49 percent) and one in three retirees (32 percent) are apprehensive about taking too much investment risk. Now, responding to the research, MassMutual announced it’s introducing a new target date fund family subadvised by a Legg Mason-affiliated manager, QS Investors, LLC, that aims to  help  reduce market volatility for retirement plan savers at this most vulnerable point. The Legg Mason Total Advantage Funds, a series of bank-maintained collective investment funds sponsored by Wilmington Trust, N.A. and available through MassMutual 401(k)s and other defined contribution retirement plans, offers retirement savers a combination of upside return potential with the goal of reduced volatility. The Funds incorporate both active and passive investment management strategies by investing in underlying funds that are managed by 16 different managers. A stable value investment component is a key part of the strategy to help retirement savers manage market volatility. The Legg Mason Total Advantage Funds’ architecture gives investors access to not only Legg Mason managers but also to an array of external managers. More info at MassMutal online.

NAIC Working on Annuity Transaction Model Law
A National Association of Insurance Commissioners working group will meet in Kansas City Thursday and Friday to try to develop an annuity transactions model law. The NAIC is attempting to adopt a model law that states can then put in place, creating a uniform standard. Some industry critics say it too closely mimics the Department of Labor fiduciary rule, while others say it doesn’t go far enough.


SF City Attorney Scrutinizes Uber, Lyft Employee Benefits
San Francisco City Attorney Dennis Herrera issued subpoenas to Uber and Lyft this week to turn over records on whether they classify drivers as employees or private contractors, as well as records on driver pay and benefits. The subpoenas follow the California Supreme Court’s recent ruling on the definition of an employee versus an independent contractor.  These subpoenas are the latest component of Herrera’s investigation into whether ride-hailing companies comply with San Francisco ordinances. In light of the California Supreme Court’s decision that companies must affirmatively prove a worker is an “independent contractor” before denying that person the wages and benefits guaranteed to California employees, Herrera seeks proof that Uber and Lyft have lawfully classified drivers as independent contractors or provide their drivers with minimum wage, sick leave, health care contributions and paid parental leave.


UNUM Delves Into Disability Causes
The newest research by UNUM, a 10-year review of disability claims, shows the effects of an aging workforce, medical advances and the power of early intervention.

Key findings include:

  • Short and long term disability claims for joint disorders and musculoskeletal issues have increased significantly.
  • Cancer has stayed the No. 1 reason for long term disability claims, representing 17 percent of claims.
  • Pregnancy continues to top the list of short term disability claims, at 28 percent.
  • Long term disability claims for complicated pregnancies, however, have decreased 47 percent.
  • The percentage of Unum’s short term disability behavioral health claims that transition to long term is down 15 percent, the result of a dedicated behavioral health program.



NAFA Annuity Leadership Forum & Hill Walk
June 13-15, Grand Hyatt, Washington, DC

Events provide an opportunity for membership to network with one another, advocate on behalf of fixed annuities and learn about ways to enhance distribution. Keynote speaker is journalist Fred Barnes. Info and registration here.

IICF Western Regional Forum
June 21, The Millennium Biltmore, Downtown Los Angeles
The one-day regional format provides opportunities for greater participation and networking with colleagues here in the West and beyond. There will be ample time for networking with speakers as well. Topic this year is Driving Diversity: Cultivating Individual and Industry Confidence. Learn more at

November 1-3, Gaylord Palms Resort and Convention Center, Orlando, Florida
Detailed information about NAILBA 37 will be available soon. Exhibit hall and sponsorship opportunities available here.  Or contact for more info.


Save the date!

Golden Gate Association of Health Underwriters
4th Annual NORCAL Medicare Summit
August 16-17, DoubleTree Hotel, Pleasanton, More info soon at

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