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Capping drug coverage for rare diseases poses an ethical dilemma

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Dave Patriarche:

The comment by Dan Berty — “We encourage small- to mid-sized employee groups to have a pooling mechanism in place to help share the cost among sponsors and insurers” — is a great idea, but the insurers have effectively removed that option for the 86.4% of small businesses under 20 employees.

Between increasing the stop-loss attachment point to $10,000 or above, while also increasing the claims experience credibility for small business, there just isn’t the pooling that is required for protection. This means that employers with high claims are forced to take large rate increases, cap drug plans or drop plans altogether. The cap or removal of the plan safely isolates the insurer from the risk.

Pooling IS the answer. Do we have an insurer, or an industry association, that is willing to step up and actually provide assistance?

Monday, January 20 at 7:56 am | Reply

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