Roughly 60% of employers offer “self-funded” health plans to their employees. For nearly 50 years, federal law and legal precedent has prevented state legislators from preempting federal laws governing these self-funded plans. This means employers with self-funded plans could expect consistency across state lines and a fair regulatory climate.
Now, lobbyists for Big Pharma and independent pharmacists are looking to increase their profits by ignoring federal law and undermining the cost-savings in self-funded plans.
Some examples of these proposals include:
Eliminating the ability of self-funded plans to incentivize shopping at pharmacies with lower prices. Employers work to drive down costs by using lower co-pays to encourage patients to visit pharmacies that sell drugs at lower prices. Maryland lawmakers are considering outlawing the use of those incentives, using government control to rewrite private contracts.
Eliminating protections from price gouging for specialty drugs and at specialty pharmacies. Physician-owned pharmacies can overcharge on specialty drugs and their lobbyists have worked to ban measures to control costs.
Attacking incentives for mail-order delivery of drugs and access to mail-order. Mail-order is cheaper and, in many cases, healthier for patients, who are more likely to adhere to their prescribed medications if they are delivered to their homes at regular intervals.
If these attacks on employer sponsored health plans are successful, the cost of prescription drugs could increase by billions of dollars in the next decade.
There are at least 177 million Americans with employer-based health coverage, compared with 120 million with other coverage and 28 million uninsured.
Employer Based Health Care Coverage
Non-Employer Based Health Coverage