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And drug plans also may start offering fewer choices for prescriptions or a narrower network of pharmacies that people can visit. The 2018 tax that is motivating companies to adjust their health insurance plans also is prompting them to narrow the list of drugs they cover, said Dr. Steve Miller, chief medical officer for Express Scripts Holding Co., the nation’s largest pharmacy benefits manager.
That means a plan may offer a choice of two options instead of three for a particular prescription. Being restrictive like that gives drug plans leverage to negotiate better prices and consequently, lower costs.
At the same time, most people can now get flu shots or fill birth control prescriptions with no out-of-pocket costs because of an overhaul provision that makes it easier for people to get preventive care.
WHAT ABOUT WELLNESS PROGRAMS?
For years, employers have tried to control medical costs by offering voluntary wellness programs that reward workers for participation. T-shirts and gym memberships progressed to discounts on employees’ share of insurance premiums if workers kept their cholesterol levels low or their weight down.
The trend got a boost from the health law starting Jan. 1, when employers could begin offering bigger incentives than previously permitted by law. The rewards now can equal up to 30 percent of the cost of health coverage. That means a worker who normally pays half of a $5,000 annual premium for health coverage could get up to a $1,500 discount for losing weight. Additional rewards are permitted for taking part in stop-smoking programs.
Employers are paying attention. The nonprofit International Foundation of Employee Benefit Plans said two in five employers are ramping up their wellness initiatives because of the law. But concerns about fairness and discrimination have been raised by unions and consumer advocates, which could dampen the trend.
Wellness rewards could end up punishing older workers and minorities who are more likely to have chronic conditions and could be forced to pay higher premiums. And some of the measurements are controversial: Body mass index, for example, can overestimate body fat in people who have a muscular build.
AP Medical Writer Carla K. Johnson reported from Chicago. AP Business Writer Tom Murphy reported from Indianapolis.
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