2024 Formulary Changes

Select Health’s announced change to their prescription drug coverage may dramatically affect your copayments and out-of-pocket maximum starting in 2024

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2024 Formulary Changes

In some situations, people on specialty medications could end up paying an additional $9,450 (individual) to $18,900 (family) out of pocket in 2024

If you’re a Select Health customer through a small employer or individual plan, there are important changes to Select Health’s RxCore five-tier formulary that you should be aware of. Beginning January 1, 2024, when Select Health members fill specialty medications at in-network specialty pharmacies, payments made using manufacturer copay assistance programs will no longer count towards their accumulators. This is set to affect Select Health customers in all states.

What this means is that if you use a drug manufacturer’s copay assistance card to help cover the cost of your medication, and you usually reach your out-of-pocket maximum early in the year, that will likely change. You will also likely end up paying more out of your own pocket for your medications. That’s because like several other health insurance companies that do not count manufacturer copay assistance towards your deductible and out-of-pocket maximum for prescriptions, Select Health is now following suit.

Here’s a short (not comprehensive) list of medications that may be affected:

Advair
Breo Ellipta
Dulera
Enbrel
Eliquis
Humalog
Humira

Invokana
Januvia
Lantus
Levitra
Lyrica
Premarin
Proair

Proventil
Restasis
Spiriva
Symbicort
Truvada
Xarelto

List from: GoodRX

Even if you don’t see your medication on the list above, if you use are using a copay assistance card to help cover a portion of the cost of the your medication, we recommend contacting the provider of your copay assistance program to determine how changes to the Select Health RxCore five-tier formulary (the list of a plan’s covered drugs) will affect you.

Select Health says this change is being implemented to help manage the high cost of health care. In a recent agent alert, Select Health noted:

As we manage health care costs for all our members, we sometimes have to make difficult decisions about the drugs we cover and how we cover them. These changes are guided by evidence-based assessments and receive approval from our Pharmacy & Therapeutics Committee.

”This could have a major impact on the affordability and access to certain medications” according to Rebecca Yates, CEO and Founder of Ark Insurance Solutions. “Even if your copay assistance program card has covered the majority of the expense for your specialty medicines in the past, this will likely change in 2024. Worst case scenario, it could mean paying an additional $9,450 (individual) to $18,900 (family) out of pocket in 2024.”

Since the amount of out-of-pocket expense could increase by thousands of dollars in 2024, Select Health customers should be proactive in reaching out to the drug company’s copay assistance program to determine the amount of the annual assistance maximum. During the past 4 years, all other Utah health insurance carriers have implemented a copay accumulator or copay maximizer program.

Helpful Resources:

Your drug manufacturer copay assistance program:
Contact the program (the phone number is often listed on your copay assistance card) for specifics on how this change will affect you. Specifically, you’ll need to ask what your annual assistance maximum (or cap) is.

Select Health:
For additional information, please visit selecthealth.org/rxfaq. To review the 2024 RxCore five-tier drug list for each state, visit selecthealth.org/pharmacy/pharmacy-coverage-2024

Navigating the complex world of health insurance can be daunting. The Ark Insurance Solutions team has the skill and experience to guide you. We’ll help you compare health plans to make the best decision based on your unique circumstances and budget. Give us a call at 801-901-7800 or click here to schedule an appointment with us.
The Long-Awaited “Family Glitch Fix” and Why It Could Be Great News for Your Family

The Long-Awaited “Family Glitch Fix” and Why It Could Be Great News for Your Family

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The Kaiser Family Foundation estimates that the “family glitch” currently affects more than 5.1 million Americans. Due to the narrow way that the IRS interpreted the affordability of health coverage as outlined in the Affordable Care Act (ACA), many people who haven’t been eligible to get ACA tax credits and affordable insurance through the Healthcare.gov marketplace, will now be able to get coverage. The new rule to fix the family glitch goes into effect on January 1, 2023, which means you can benefit from it right away!


The Long-Awaited “Family Glitch Fix” and Why It Could Be Great News for Your Family

This post was updated on December 18, 2022. 

Imagine this scenario. Tom gets great insurance through his company and his boss pays 100% of his insurance premium because he wants to be sure all his employees are covered.

Tom’s wife Amanda, and their two kids, also need coverage under Tom’s insurance. Here’s the problem. The cost to add Amanda and the kids to Tom’s plan is $1,100 per month. This is unfeasible for the couple since their combined income is around $5,500 per month.

One would think that Amanda and the kids could just go through the Healthcare.gov marketplace and get an affordable health plan. But the fact is, she and the kids have not been eligible to receive Affordable Care Act tax credits to get insurance through the marketplace since they are technically eligible to get coverage on Tom’s plan — at a mind-numbing cost of $1,100 per month.

Under the ACA’s affordability test, Amanda and the kids could have gotten affordable coverage through the healthcare marketplace, if the cost of Tom’s portion of his insurance premium exceeded 9.61% of the entire household income. But since the amount that Tom has to pay for insurance coverage each month is zero (remember his generous boss?), and $0 is definitely not more than 9.61% of $5,500, Amanda and the kids are out of luck.

Now you might be asking, “wouldn’t the high cost to add Amanda and the kids to Tom’s plan be used for the affordability test? $1,100 is definitely more than 9.61% of their monthly household income.”

Well that’s the “family glitch.” When the act was written, it didn’t take into account the affordability of health insurance for dependents, only the employee’s cost of health insurance — measured against the entire family’s income. Very glitchy.

So here’s what’s changing. With the Biden Administration’s final rule on the “Family Glitch Fix”, families will get a break. When the new rule takes effect, the affordability of insurance premiums will be based on the cost of premiums to get all dependents covered, not just the employee’s cost for his/her/their own coverage.

This means that many more people will be able to get ACA Tax Credits and get insurance through the Healthcare.gov marketplace. The “Family Glitch Fix” will take effect on January 1, 2023 which means that individuals and families can sign up for more affordable plans during Health Insurance Open Enrollment which is running through Jan. 15, 2023.

To find out what the Family Glitch Fix might mean for you and your family, make an appointment with an Ark Insurance agent today.

Navigating the complex world of health insurance can be daunting. The Ark Insurance Solutions team has the skill and experience to guide you. We’ll help you compare health plans to make the best decision based on your unique circumstances and budget. Give us a call at 801-901-7800 or click here to schedule an appointment with us.
Spring cleaning beyond the home | Ark Insurance Solutions

Spring Cleaning Beyond the Home

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Spring is a time of renewal. Trees are budding, flowers are blooming and we tend to clean house with windows open, dusting off winter. One area of house cleaning you may not think to dive into is your beauty products. Keeping your products clean, and getting rid of old products, is important not only for hygienic purposes, but they can be breeding grounds for bacteria and fungi, especially makeup brushes.

 

Don’t share makeup.

Everyone has different body chemistry and sharing products you use can cause the spread of viruses and inflammation. For example, using someone’s lipstick can pass along the cold sore virus or using someone’s mascara can spread pink eye or other eye infections.

Clean those makeup brushes.

No need to buy a special cleaner for this, using a mild soap or shampoo is sufficient. Put a small amount in your hand and swirl the brush around, rinse well, and dry upright or flat. This is also a good time to wash out that cosmetic bag and those tweezers.

Purge products every six months if they are a liquid or a cream.

This includes liquid eyeliner and mascara, they can collect bacteria that causes eye infections. Powders tend to last a bit longer, so your sparkle powder eyeshadow has a few more months in them.Store beauty products in a cool, dry space. Humidity and heat can accelerate the growth of fungi and bacteria.

One final tip, when in doubt, throw it out. Holding on to something that may be contaminated is not worth the risk of illness or infections.

 

Always the Journey with Jason Woodland and Rebecca Yates

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Jason Woodland interviews CEO Rebecca Yates discussing what she does for Ark Insurance Solutions clients as well as her contributions in the health insurance industry on a national scale.

 

Listen in here:

https://youtu.be/gV6w9fOCa5o

 

From Jason Woodland:

Welcome to interview #45 of Always the Journey TV with Rebecca Yates, CEO of Ark Insurance, LLC. In this interview, we’ll learn more about what inspired Rebecca to join the health insurance industry and what she does to help her clients.

Rebecca is very passionate about providing appropriate insurance coverage to her clients, taking the time to learn their needs, and design unique programs. Her varied background and experience with both large partially self-funded groups, small fully insured groups, and individuals/families bring a unique perspective to all of her endeavors.

 

As the health insurance industry is always changing, she consistently takes the time to learn the changes and ensure that all of her clients are kept up to date. She also speaks on issues such as Health Care Reform, health insurance partial self-funding, ERISA 101, and health insurance basics. She loves to read, improve her home, start businesses, and travel. She has two daughters and two very naughty puppies that she adores.

CDC

CDC Decision Tree For Re-Opening Your Business

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Courtesy of the CDC

Huntsman Mental Health Institute Coming to University of Utah

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The University of Utah President Ruth Watkins, announced on November 4, 2019  the Hunstman family has pledged $150 million to establish a mental health institute at the University of Utah.

 

“Suicide is increasing as a cause of death,” said Michael Good, University of Utah senior vice president for health services, CEO of University of Utah Health, and Dean of the University of Utah School of Medicine. “There just aren’t enough mental health professionals. We need to do better. This generous gift from the Huntsman family will allow us to support enhanced training for mental health professionals. It will allow us to reimagine care teams and how to better deliver mental health services across our state and across our region.” (ksltv.com)

 

The grant agreement also states the university will work with the Huntsman family to raise additional funds to increase community awareness in regards to mental health issues and will also provide financial support to the University Neuropsychiatric Institute (UNI) and to support mental health screenings to the 32,000 students including in rural areas.

Local Farmers Markets

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Have you visited a local Farmers Market yet? The open-aired markets are the perfect place to buy locally grown produce and products made by local artisans. And now, you can find one in just about any area of the valley and Park City.

 

Here are few to check out: 

 

Wheeler Historic Farm- All the charm of a working farm with the added bonus of the market on Sundays. Find crafts, fruit, honey, baked goods and more!

 

Wheeler Farm

6351 S. 900 E.

Now thru October 27

Sunday’s, 9am-2pm

 

Sugar House Farmer’s Market- This market has the feel of the neighborhood. Local products focus on having a Sugar House flair. Enjoy fresh produce, unique craft artisans and delicious foods on a Wednesday evening.

 

Fairmont Park

Now thru October

Wednesdays, 5-8pm

 

Downtown Farmers Market-Salt Lake’s longest running summer tradition, now in its 28th year, takes place on Saturday and supports local farmers and producers by offering a large variety of fresh fruits, vegetables, grass-fed beef, locally made baked goods and other culinary goods.

 

Pioneer Park

Now thru October 19

Saturdays, 8am-2pm

 

Park Silly Market- The Park Silly market takes place on Sundays on Park City’s Historic Main street. Lining the street, you will find artisans, local foods, jewelers and local products.

 

Park City’s Historic Main Street

Now thru September 22

Sundays, 10am-5pm

 

Daybreak Farmers Market- Now in its second summer season, the Daybreak Farmers Market has become a hit with the neighborhood. Here you will find small producers, organic produce, wild seafood and many other vendors creating leather goods, pottery and more.

 

Daybreak-11274 Kestrel Rise Road

Now thru September 28

Saturdays, 10am-1pm

 

 

Important News From Aetna

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On October 10, 2018 we learned that the Department of Justice (DOJ) will allow CVS Health’s acquisition of Aetna to proceed.

Under the DOJ consent decree, closing of the CVS Health-Aetna transaction may proceed prior to the effective date of Aetna’s previously announced divestiture of its entire standalone Medicare Part D business to a subsidiary of WellCare Health Plans, Inc.

You do not need to do anything new or different as a result of this announcement.  Aetna and CVS Health will continue to operate as separate companies until the CVS Health transaction is complete.

While the DOJ decision is an important step toward finalizing the CVS Health transaction, closing remains subject to certain state regulatory approvals and satisfaction of other closing conditions. We continue to expect the CVS Health transaction to close this year.

We value our relationship, and will keep you informed every step of the way in accordance with the terms of our current agreements. 

 

Source: This message is for informational purposes only, is not medical advice and is not intended to be a substitute for proper medical care provided by a physician. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to aetna.com.

Insurance Broker and Business Owner, Rebecca Yates, Also Advocates for Change

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Current Vice President of Vest Pocket Business Coalition Rebecca Yates, owner of Ark Insurance Solutions, was looking for more opportunities to learn about political advocacy when she joined Vest Pocket in 2016. Yates has a daughter with Autism and advocating for an education bill got her up on Capitol hill for the first time.

“I have always been passionate about small business, I have grown as a business owner and a person, having been involved with Vest Pocket,” Yates said. “Being able to set up a series on addressing the mental health of business owners, where studies have shown that they are under the same levels of stress similar to combat veterans, has been a great opportunity. We need more members so we can really start effecting change.”

Vest Pocket is a collaborative association of Utah’s locally owned small businesses that was born out of necessity in 1997. The issue that sparked the first movement, were local parking ordinances that were put into place making parking very difficult for certain small business owners and their customers. Together, those businesses banded together and fought to make changes that would accommodate the needs of the businesses, the consumer and the city.

Read the full article at http://utahstories.com/2018/02/starting-a-small-business-where-do-you-go-for-help/

To learn more about Vest Pocket visit http://www.vestpocket.org