Lesson Quiz: Introduction to the Health Rosetta

What is the proper name for a carbonated beverage?

Case Study: Rural Manufacturer (see above)

Question #2: What information would you request to allow for a more thorough recommendation? Explain how this information will allow you to design a plan that is mindful of employer budget constraints while avoiding more cost shift to employers.

Case Study: Cancer Case

You are the advisor for a 250 life self-funded employer with a $150K deductible. The current plan administration is with a BUCAH TPA and PPO network.

There is only one specific stop loss claimant – 61 year old male diagnosis of malignant melanoma. The patient is prescribed Opdivo and is approved for 14 cycles initially and the protocol is 26 treatments if patient tolerates. Opdivo is used to treat people with a type of advanced stage cancer that has spread or grown and is used for people who have tried chemotherapy and it did not work or is no longer working. The average cost through a PBM is $6500/cycle. The administration of Opdivo is being done in a hospital outpatient setting and the billed charges by the hospital through the medical benefit are $27K per treatment with an amount paid after a 35% discount of $17K per treatment. The stop loss provider is concerned about projected costs and is considering a laser for the cancer patient.

Question #1: What is your plan to mitigate the laser?