Friday, February 17, 2012

Pharmacy Benefit Manager (PBM) Contract

Pharmacy Benefit Manager (PBM) Contracts

Ohio Bureau of Workers' Compensation: New Grant Program

To meet the challenges of obesity, the rising incidence of chronic diseases and the aging workforce, BWC has established the Workplace Wellness Grant Program.

The program’s goal is to limit and control the escalating cost of workers’ compensation claims through addressing health risk factors. The secondary goals are to reduce health-care costs for employers, as well as improve the heath of the workforce. 

 Eligibility Requirements:
  • Be a state-fund employer
  • Current on monies owed to BWC
  • Employer does not currently have a wellness program that measures health-risk factors, and
  • Employer must contract with a third party vendor that provides these services.
BWC will provide a total of $15,000 to each employer until the grant funds are not longer available. Employers participating in the grant fund may re-ceive $300 per participating employee over a four year period.
  • Year One: $100
  • Year Two: $75
  • Year Three: $75
  • Year Four: $50
How to apply:
1. Complete all application questions.
2. Take online safety self-assessment
3. Execute the wellness program vendor contract
4. Provide vendor name
5. Submit application, safety assessment, and a copy of the wellness pro-gram vendor to contact
6. Complete and submit baseline data (Health Risk Assessments and Bio-metric Screenings) within 3 months of receiving BWC’s approval to participate in the grant program.
7. Provide receipt documents within three months of receiving grant funds.

Program participants must report data elements to BWC annually, and must submit a year-end case study that explains what they have done to create and implement their workplace wellness program.

Employers must qualify to receive these funds for the entire four-year period. To continue to receive funds for the remaining three years, the employer must complete the prior years requirements, including reporting all requested data elements and submitting the year end case study.

Employers may apply for the workplace wellness grant through an online application available at:

More information regarding the program can be found here:

Health Care Reform: Compromise on Contraceptive Coverage for Religious Employers

Compromise on Contraceptive Coverage for Religious Employers
Under health care reform, non-grandfathered health plans must cover women’s preventive care services, including contraception, without charging a co-pay or deductible. This rule is effective as soon as August 2012 for some plans.
Churches, other houses of worship and similar organizations are exempt from covering contraception on the basis of their religious objections. However, this exemption does not cover other church-affiliated institutions, such as schools, charities, hospitals and universities.
On Feb. 10, 2012, President Obama announced a proposal to address objections of non-exempt religious organizations. Under this proposal, the organization may choose whether or not to cover contraceptives. The insurance company providing coverage would be required to cover contraception if the religious organization chooses not to.
The health care reform law requires non-grandfathered health plans to cover preventive health services without imposing cost-sharing requirements, effective for plan years beginning on or after Sept. 23, 2010. In August 2011, the Department of Health and Human Services (HHS) issued additional preventive care guidelines for women, including contraceptives, effective for plan years beginning on or after Aug. 1, 2012.
On Aug. 3, 2011, HHS issued an amendment to the women’s preventive care guidelines to allow certain non-profit religious employers offering health coverage to decide whether or not to cover contraceptive services, consistent with their beliefs. A non-profit religious employer, for this purpose, is an employer that has the inculcation of religious values as its purpose, primarily employs persons who share its religious beliefs and primarily serves persons who share its religious beliefs. This exemption covers churches and similar organizations.  
On Jan. 20, 2012, HHS announced a one-year delay to the contraceptive coverage requirement for non-profit employers that do not qualify for the exemption and do not provide contraceptive coverage to employees based on religious beliefs. Church and religious leaders objected, arguing that the coverage requirement violates their organizations’ religious freedoms and that the delay is not an adequate solution. According to the White House, the President’s proposal is an attempt to balance religious liberty with the health of women.
There will continue to be a one-year transition period for non-exempt religious organizations. During the transition period, a new regulation will be drafted. Under the new regulation, religious organizations, such as schools, charities, hospitals and universities, will not have to provide contraceptive coverage, refer their employees to organizations that provide contraception or subsidize the cost of contraception.
However, under the new regulation, female employees of these entities will receive free preventive care that includes contraceptive services. Specifically, contraception coverage will be offered to women by their employers’ insurance companies directly, free of charge, with no role for religious employers that oppose contraception.
Additional details of the policy will need to be finalized, such as how it applies to self-funded health plans. Also, the new policy does not affect existing state insurance requirements concerning contraception coverage.