Worcester Business Journal

Worcester Business Journal www.wbjournal.com 2016 Economic Forecast 25 H E A LT H C A R E S P O N S O R E D B Y W hile medical plan costs are expected to rise modestly, the big health care cost driver in 2016 will be prescription drugs. Cost trend rates for drugs are expected to reach double digits, according to the 2016 Segal Health Plan Cost Trend Survey. The continued climb in prescription drug utilization rates and the growing popularity of very high-cost specialty drugs are two key reasons behind the increase. Advice for consumers: take the tried-and-true approach of asking prescribers for less costly alternatives or generics, while also taking advantage of potential savings from mail service prescriptions for maintenance medications. What are insurers doing to help combat rising drug costs? One example: Harvard Pilgrim has negotiated a discount with the maker of the hepatitis C drug, Harvoni, which will result in millions of dollars in savings for our customers. Savings opportunities will continue to be available through network plan designs, which include high-performance defined and tiered networks. The choice, flexibility and cost savings of these plans enable employers to offer new options, while retaining the same benefit levels. The network designs also take the "consumer- driven" aspect of health care to a higher level of engagement by bringing provider cost and quality considerations to the forefront when members choose a plan and seek care. For example, Harvard Pilgrim's Focus Network SM - MA* is helping employers manage costs by providing premium savings when they choose this defined network of high-quality, cost-effective providers. And our ChoiceNet tiered network offers the opportunity for members to save on out-of-pocket costs by choosing lower-tier, higher-quality providers when they need care. If the notion of 50-to-100-and-then-back- to-50 sounds familiar, you've likely been affected by events surrounding the Affordable Care Act's (ACA) redefinition of small group size. Scheduled to take effect beginning in 2016, the size redefinition led to a great deal of planning and strategizing by employers, benefits advisors and insurers. However, in October 2015, new legislation changed the game by giving states the option to keep their current small group size definition. Massachusetts did just that, choosing to keep its definition of small groups as having up to 50 eligible employees. With that flurry of activity behind us, there are no significant ACA changes planned for 2016. On the other hand, it just happens to be a major election year, and depending on the outcome, the ACA landscape could shift. Or not. Stay tuned … n 2016 Health Care Outlook Prescription for sticker shock, network plan savings and ACA ping-pong *is plan provides access to a Limited Provider Network that is smaller than Harvard Pilgrim's full provider network. For additional information, visit harvardpilgrim.org/Focus.

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