Momentum Builds for Single Leave Mandate
Earlier this year I identified the key disability management-related themes of 2016. The trend of offering paid parental leave is now gaining momentum.
At the end of March, New York state became the fifth state to mandate this type of leave. The program provides employees up to 12 weeks paid time to bond with a new child or to care for a parent, child, spouse, domestic partner, or other family member with a serious health condition.
The duration of the leave doubles the six weeks allotted in California and New Jersey, and is triple the four weeks of paid leave Rhode Island offers.
New York’s law does away with many of the exceptions in similar laws. It will cover full-time and part-time employees, and there will be no exemptions for small businesses. Employees only need to be employed by the company for six months to be eligible.
This raises an important point. Most of the paid leave action is with large companies.
The law does allow employers to limit two employees from taking this benefit at the same time for the same family member, limiting exposure in the case of more than one family member working for the same employer.
Although New York’s paid leave law takes effect on January 1, 2018, it will be gradually phased in with only eight weeks of leave with a 50 percent of pay cap, increasing ultimately to the full 12 weeks at a 67 percent cap by 2021. As is the trend, this is an employee funded benefit through a weekly payroll tax of approximately $1 per employee.
In April, San Francisco’s Board of Supervisors passed the Paid Parental Leave Ordinance (PPLO), making it the first city in the country to enact such an ordinance.
This new law provides supplemental compensation for California employees receiving partially paid leave under California’s Paid Family Leave (PFL) law to bond with a newborn child or newly placed child for adoption or foster care, among other reasons.
During the leave period, the employer will be required to supplement employee pay, so the combination of monies received under the PFL (currently 55 percent wage replacement) and the PPLO will provide compensation equal to 100 percent of the employee’s gross weekly wage.
Payment is made from a worker-funded state disability program and calculated as a percentage of the employee’s wages (55 percent) subject to the maximum weekly benefit amount set by the PFL program. Very similar to the state PFL, there is a cap on the maximum weekly benefit amount of $924, which equates to an individual with a salary of $106,740.
San Francisco’s law will be phased in quickly. In January 2018, all companies with 20 or more employees, with any of those individuals regularly employed in San Francisco, will be required to comply.
Since February, there have been almost weekly announcements about employers adopting or improving their paid leave policies. Here is just a sampling:
- Twitter: 20 weeks of paid parental leave
- Wells Fargo: 16 weeks of paid leave
- Anheuser-Busch: 16 weeks of maternal leave; 2 weeks of paid leave for secondary caregiver (male or female)
Whether aimed at employee attraction or retention, paid leave is now becoming a “must-have” for large organizations.
This raises an important point. Most of the paid leave action is with large companies.
According to the American Action Forum, in companies with 500 or more employees, paid family leave rose a solid 5 percent, from 17 percent in 2010 to 22 percent in 2015. But in companies with fewer than 50 employees, the needle has only moved from 7 percent to 8 percent from 2010 through 2015.
The myriad of laws, regulations, and policies is creating an administrative burden for all companies. And, for many smaller employers, the varying laws and policies are creating an actual competitive disadvantage.
It is likely that employers of all sizes would welcome some consistency in these laws that are leaving some to ask, “Who is going to pay for all of this?”
2016 Outlook: Disability and Absence Management
The disability and absence management landscape continues to experience rapid change. The driving forces are legal and regulatory and a shift in social attitudes about work-life balance. It can be a challenge to keep up; however, there is also great opportunity for disability and absence management professionals to expand their skills and increase their value.
Here are five trends to watch for in 2016:
Paid Leave: A True National Issue
If paid family and sick leave were issues in 2015, they will be the issues of 2016. More large employers will follow the likes of Netflix, Facebook, Microsoft, Adobe, Apple, Amazon, and other leading companies to implement or expand their own leave policies.
And there will be even more efforts to pass paid leave laws in cities and states, including Washington, D.C. and Maryland. Perhaps as important, the democratic presidential nominee will seek to build on FMLA and make paid federal leave a significant campaign issue.
This means more complex process management, heightened compliance demands, and increased public attention to organizations that come under legal or other scrutiny. 2016 is the year in which large numbers of disability and absence management professionals become leave law experts.
ADA Administration Drives Increased Partnering
As with FMLA, more employees than ever are aware of their rights under the ADA. As a result, growing numbers of employers will look to their current short-term disability (STD), long-term disability (LTD) insurance and FMLA partners to help them manage the ADA process.
There are tools and resources, including automated software systems, to help employers manage the accommodation requests and processes associated with ADA. These tools are increasingly cost effective. We will continue to see an increase in partnering to manage growing employee awareness and the accompanying compliance demands.
Workforce Well-Being Moves Front and Center
The Affordable Care Act has given a large and sustained push to preventing illness. This directly impacts the absence and/or disability that accompanies those illnesses.
From gym memberships as a nice employee benefit to workforce well-being, it has moved to a key tool in controlling health care costs. Disability and absence management professionals are being called on to play a larger role in designing and implementing these programs. That will accelerate in 2016.
In addition, an even larger part of workplace well-being will be an emphasis on behavioral health. More disability and absence management professionals, as well as health practitioners, understand the connection between the mind and body in absence, disability, and overall health.
Depression and other mental health issues are increasingly recognized as topics of major concern when it comes to employee well-being. Attention given to these areas brings lower health-related costs, including those related productivity.
Expanded Professional Opportunities
As leave and health care change, absence and disability professionals are confronted with significant new demands. They need to be aware of laws and regulations and new approaches to minimizing health care costs.
In progressive companies, this translates into organization-wide cooperation that enables disability professionals to collaborate with different departments.
This presents professionals with tremendous opportunities to expand their networks, skills, and credentials. 2016 will see at least one new professional designation.
With it and the continued accumulation of new skills, disability and absence management professionals will add more value to their organizations. The result will be a new level of professional and personal rewards.
Increase in Strategic Enforcement From the EEOC
The EEOC’s interest has shifted from individual violations to more systemic workplace discrimination and this includes pregnancy discrimination. Systemic investigations and cases are effective at addressing workplace discrimination issues on a broad scale in an industry, profession, company, or even a specific geographic area.
The EEOC issued guidance making clear that failing to accommodate pregnant employees may expose employers to Americans with Disabilities Act claims based on temporary disabilities caused by pregnancy.
So what does this mean for you in 2016? Employers will need to ensure they are paying attention to policies, practices, and processes for employees taking leave.
Leave has become a political and social issue. It, along with all forms of absence and disability, have caught the attention of many in the “C suite”. That means we will all hear more about these topics in 2016.
Compounding: Is it Coming of Age?
The WC managed care market has generally viewed the treatment method of Rx compounding through the lens of its negative impact to cost for treating chronic pain without examining fully the opportunity to utilize “best practice” prescription compounds to help combat the opioid epidemic this nation faces. IPS stands on the front lines of this opioid battle every day making a difference for its clients.
After a shaky start cost-wise, prescription drug compounding is turning the corner in managing chronic pain without the risk of opioid addiction. A push from forward-thinking states and workers’ compensation PBMs who have the networks and resources to manage it is helping, too.
Prescription drug compounding has been around for more than a decade, but after a rocky start (primarily in terms of cost), compounding is finally coming into its own as an effective chronic pain management strategy – and a worthy alternative for costly and dangerous opioids – in workers’ compensation.
According to Greg Todd, CEO and founder of Integrated Prescription Solutions Inc. (IPS), a Costa Mesa, Calif.-based pharmacy benefit manager (PBM) for the workers’ compensation and disability market, one reason compounding is beginning to hit its stride is because some states have enacted laws to manage it more effectively. Another is PBMs like IPS have stepped up and are now managing compound drugs in a much more proactive manner from an oversight perspective.
By definition, compounding is a practice through which a licensed pharmacist or physician (or, in the case of an outsourcing facility, a person under the supervision of a licensed pharmacist) combines, mixes, or alters ingredients of a drug to create a medication tailored to the needs of an individual patient.
During that decade, Todd explains, opioids have filled the chronic pain management needs gap, bringing with them an enormous amount of problems as the ensuing addiction epidemic sweeping the nation resulted in the proliferation and over-consumption of opioids – at a staggering cost to both the bottom line and society at large.
As an alternative, compounded topical cream formulations also offer strong chronic pain management but have limited side effects and require much reduced dosage amounts to achieve effective tissue level penetration. In fact, they have a very low systemic absorption rate.
Bottom line, compounding provides prescribers with an excellent alternative treatment modality for chronic pain patients, both early and late stage, Todd says.
Time for Compounding Consideration
That scenario sets up the perfect argument for compounding, because for one thing, doctors are seeking a new solution, with all the pressure and scrutiny they’re receiving when trying to solve people’s chronic pain problems using opioids.
Todd explains the best news about neuropathic pain treatment using compounded topical analgesic creams is the results are outstanding, both in terms of patient satisfaction in VAS pain reduction but also in reduction potentially dangerous side effects of opioids.
The main issue with some of the early topical creams created via compounding was their high costs. In the early years, compounding, which does not require FDA approval, had little oversight or controls in place. But in the past few years, the workers compensation industry began to take notice of the solid science. At the same time, medical providers also were seeing the same science and began writing more prescriptions for compounding – which also offers them a revenue stream.
This is where oversight and rigor on the part of a PBM can make a difference, Todd says.
“You don’t let that compounded drug get dispensed when you’re going to pay for it without having a chance to approve it,” Todd says.
Education is Critical
At the same time, there is the growing, and genuine, need to start educating the doctors, helping them understand how they can really deliver quality pain management to a patient without gouging the system. A good compounding specialty pharmacy network offering tight, strict rules is fundamental, Todd says. And that means one that really reaches out to work with the doctors that are writing the prescriptions. The idea is to ensure that the active ingredients being chosen aren’t the most expensive sub-components because that unnecessarily will drive the cost of overall compound “through the ceiling.”
IPS has been able to mitigate costs in the last couple years just by having good common sense approach and a lot of physician outreach. Working with DermaTran Health Solutions and its national network of compounding pharmacies, IPS has been successfully impacting the cost while not reducing the effectiveness of a compounded prescription.
In Colorado, which has cracked down on compounding profiteering, Legislative change demanded no compound could be more than $350.00 period. What is notable, in an 18-month window for one client in Colorado, IPS had 38 compound prescriptions come through the door and each had between 4 and 7 active ingredients. Through its physician education efforts, IPS brought all 38 prescriptions down 3 active ingredients or less. IPS also helped patients achieve therapeutic success (and with medical community acceptance). In that case, the cost of compound prescriptions was down to an average of $350, versus the industry average of $788. Nationwide IPS has reduced the average cost of a compound prescription to $478.00.
Todd says. “We’ve still got a way to go, but we’ve made amazing progress in just the past couple of years on the cost and effective use of compound prescriptions.”
For more information on how you can better manage your costs for compound prescriptions, please call IPS at 866-846-9279.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with IPS. The editorial staff of Risk & Insurance had no role in its preparation.