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Drug benefit reviewed by employers due to tax change

Drug benefit reviewed by employers due to tax change

Employers are turning to alternative financing strategies as they face the loss of a federal tax deduction in 2013 for a subsidy they receive for providing drug coverage to Medicare-eligible retirees. While most companies are implementing an employer group waiver plan, many anticipate ending direct sponsorship of the drug benefit by giving a defined contribution to retirees to purchase coverage in the individual market, observers say.

Under an EGWP, a Medicare Part D plan is offered to retirees through a pharmacy benefit manager or insurer that contracts directly with the Centers for Medicare & Medicaid Services. An employer wraps a supplemental plan around the Part D plan to close the gap in coverage known as the doughnut hole.

The 2003 law that created the Medicare Part D prescription drug program gave employers powerful tax incentives to retain the prescription drug plans they offered to Medicare-eligible retirees.

Employers received tax-free payments from the government based on a percentage of prescription drug expenses. In addition, employers could continue to take a full tax deduction for prescription drug expenses.

The 2010 health care reform law continued the tax-free status of the subsidy to employers but, starting in 2013, their tax deduction for prescription drug expenses must be reduced by any subsidy amounts received.

For example, assume an employer paid $100 in prescription drug expenses for a Medicare-eligible retiree and received a $30 government subsidy. In that example, under the health care reform law change, the employer could only take a $70 deduction for the expense.


As a result, “Most large employers have decided to implement an EGWP,” said Sherri Bockhorst, principal for health and productivity at Buck Consultants L.L.C. in St. Louis.

Furthermore, a final CMS regulation released in April further enhanced the value of EGWPs by eliminating the need to wrap a supplemental/wrap plan to take advantage of additional pharmaceutical manufacturer discounts in the doughnut hole. The new regulation effectively simplifies the administration by allowing EGWPs to achieve the same results without the need to split the benefit between a Part D plan which did not cover brand drugs in the doughnut hole and wrap plan that filled in that gap. This will result in substantial additional savings for EGWPs in general.

Implementing an EGWP could result in pretax costs 20% lower than what employers pay for retiree drug coverage under the Retiree Drug Subsidy program, said Martin Hill, director and actuary at PricewaterhouseCoopers L.L.P.'s human resource services in New York.

The 2012 Towers Watson/ National Business Group on Health annual employer survey showed that 57% of employers plan to or are considering implementing an EGWP over the next three years. A November 2011 survey by Aon Hewitt showed that 62% of plan sponsors who have already decided to change their Medicare Part D retiree strategy are implementing an EGWP.

“Early adopters typically gravitated toward the EGWP,” said John Grosso, health care actuary and leader of Aon Hewitt's retiree health care subpractice in Norwalk, Conn. “It requires less analysis, and fewer approvals are required than for sending people to the open market” to buy cover.


ConAgra Foods Inc., which will implement an EGWP on Jan. 1, 2013, for most of its retirees, “decided to work with a PBM far earlier than otherwise,” said Bart Karlson, Omaha, Neb.-based ConAgra's senior director of benefits. One advantage is ConAgra could account for the additional liability of the RDS change on its 2011 financial statement, he said.

With the EGWP, ConAgra is able “to keep pretty much the same benefits” for retirees, and benefits were improved for some groups as plans were consolidated, he said.

The second most-popular strategy, called the Connector model, is for an employer to give a retiree a defined contribution to purchase Part D coverage through a private administrative entity or insurer, sources said. The Aon Hewitt survey showed that 19% of employers plan to use the defined contribution approach.

The Towers Watson survey said that 53% of companies have considered or will consider dropping their employer-managed drug coverage for Medicare-eligible employees and relying on Part D plans. Mark Olson, senior consulting actuary at Towers Watson & Co. in Boston, said that some of those companies will provide a defined subsidy to purchase a Part D plan, while others may not.

“We think that most employers over time will have defined contribution subsidy funding,” although they may begin with an EGWP, Mr. Grosso said. “There are pretty strong arguments to be made for a company to send retirees to the individual market,” he said, including “the robustness of the individual market and Part D enhancements,” such as the phase-out of the doughnut hole.


ConAgra is using the Connector model for about 6,000 of its retirees, some of whom worked for companies ConAgra acquired. Through My Medicare Advocate, sponsored by ACS, the parent of Buck Consultants bought by Xerox in 2010, retirees will be able to choose among several Medicare Advantage plans, Mr. Karlson said.

This story is from the May 7, 2012, issue of the weekly print edition of Business Insurance, a special theme issue featuring an in-depth look at the alternative funding options employers can use to help rein in the costs of health care insurance for their workforce.

Copies of this issue, which includes a data poster that tracks the changes in health care costs and rates of increase for the past decade, are available for $100 by contacting our Single Copy Sales department at 888-446-1422.

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