Need direction on issues involved in carving out New York chronic illness plagued employees (50-60)as a class under a fully insured healthplan . I see issues under HIPAA and ERISA and adverse selection not to mention discrimination. A New York pharmacy has developed a niche market for packaging the RX to provide the employees that have chronic medication requirements with 30 day supply of scripted medications packaged by doasage. The health plan insurer recognizes this pharmacy but will not carve out the affected employees. The pharmacy/packaging company also wants no copays and AWP-9% versus the carriers AWP-12%. Because fully insured plans are on file with the state of New York - this would also violate the filings for the carrier - If someone has some insight and direction I would certainly appreciate it and so would my client. Total group size is 400 full-time employees. Thanks
Thanks

Why the need for carving out? Why not just let the employees know that this deal is available so that those who like it can take it and those who dont't don't? Not everyone likes to have someone messing with their medication, Which brings up the question of whether or not the insurer allows such packaging and whether or not the Drs will allow it for their patients assuming that it is even practical for many of these afflicted employees.

I personally would question whether or nor this packaging is even a good idea in the first place.