The Malone Company

09/02/2025

If your business has 2 or more employees, you have access to group health benefit options available to Chamber members through Aetna and our local partner, The Malone Company.

Why explore this now?

• Options for employers with 2+ employees
• Customizable plan designs to fit your budget and team
• Local service & enrollment support from a trusted advisor
• A powerful tool to attract and retain talent

Start the conversation today:

Contact Jim Malone, The Malone Company

📞 931-993-9438

Feel free to forward this to your HR or billing contact so they can connect directly with Jim.

08/11/2025

05/28/2025

It’s , and we’re sharing some things that can adversely affect your mental health. Remember to take it easy and use resources like TimelyCare — free to the — to get help. What do you do for self-care when feeling overwhelmed? Let us know, and remember that it’s okay not to be okay. You matter. ❤️

05/28/2025

May is —a great time to check in on yourself & your loved ones. If you or someone in you know needs help, confidential support & treatment options are available.

💚 Help yourself & share to help others: http://samhsa.gov/find-help

03/02/2025

New month, new opportunity! Make sure you register to attend the free lunch and learn on March 7th. Dr. Bonnie Lee will be sharing why colonoscopy screenings are important. Call us to register (931) 438-7426.

01/31/2025

Make 2025 the year you rethink how you're approaching your employee benefit package.

Instead of the same-old, same-old, dig deeper into what's working for employees, how you're engaging with them around those offerings, and what results you want to see in the coming year. An expert from The Malone Company says employers need to focus on closing healthcare gaps, supporting multiple life stages at once, and frequently assessing the ROI of what you're offering now.

01/10/2025

01/10/2025

Which drugs cost Medicare the most?

AARP releases list, hails importance of negotiating

Ken Alltucker

USA TODAY

Popular diabetes drugs such as Ozempic and Trulicity are among 25 drugs Medicare has spent the most on but hasn’t yet selected for price negotiation, according to a report released Thursday.

The report from the AARP Public Policy Institute said average list prices on these 25 drugs have nearly doubled since they hit the market and collectively cost Medicare – and therefore American taxpayers – nearly $50billion in 2022.

About 7million older adults on Medicare used these drugs and had to pay a portion of the bill at the pharmacy or via mail order.

One in five older adults doesn’t fill prescriptions, or skips doses to save money, the report said.

About 53million Americans were enrolled in a Medicare prescription drug plan in 2024.

Enrollees who take the priciest drugs will get some relief this year with a $2,000 cap on drug costs.

But AARP officials said the report underscores the importance of empowering Medicare to negotiate prices on behalf of enrollees and taxpayers.

'We really are seeing these remarkable price increases year after year,' said Leigh Purvis, prescription drug policy principal at the AARP Public Policy Institute. 'It’s so important to try to discourage drug companies from taking these regular price increases.'

Medicare bargains with drugmakers

Under legislation passed in 2022 called the Inflation Reduction Act, Medicare was allowed for the first time to negotiate prices with drug companies on a limited number of medications.

For the first round of bargaining, Medicare negotiated discounts that will range from 38% to 79% when the prices take effect in 2026.

The drugs are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and the insulins Fiasp and NovoLog.

Medicare will announce the next 15 drugs by Feb.1 and negotiate prices that will take effect Jan.1, 2027. Another 15 drugs will be selected in 2026 for negotiated prices that will be rolled out in 2028.

Purvis said it’s a 'safe bet' that some of the 25 drugs listed in AARP’s report will be in the next round of Medicare negotiations. Retail drugs that have no generic equivalent and have been on the market for at least seven years can be eligible for negotiation. Biologic drugs, which are derived from living cells, aren’t subject to negotiation until they’ve been on the market at least 11 years.

AARP said five drugs that accounted for the largest share of Medicare spending included the diabetes drugs Trulicity and Ozempic, the asthma drug Trelegy Ellipta, the HIV medication Biktarvy and the cancer drug Xtandi.

The list price on Merck’s diabetes drug Janumet has increased 293% since it hit the market in 2007, the largest hike among all 25 drugs, according to the report.

By contrast, the list price of hepatitis C drug Epclusa hasn’t increased since it was approved in 2016.

The Pharmaceutical Research and Manufacturers of America, a trade group representing drug manufacturers, said any study that relies on list prices is misleading because it doesn’t describe what people pay after rebates and insurance discounts are applied. When such discounts and rebates are factored, the net prices of drugs have fallen for the last six years, the trade group said.

Drug companies face inflation penalty

List prices on 20 of the drugs increased faster than the rate of inflation. Under the 2022 federal law, drugmakers must pay rebates to Medicare if list prices increase faster than inflation.

Medicare price negotiations and rebates for drugs whose prices rise faster than inflation are both important tools to help taxpayers and consumers save on drug spending, said Juliette Cubanski, deputy director of the program on Medicare policy at KFF, a health policy nonprofit.

'It doesn’t do anything to prevent manufacturers from bringing drugs to market with high prices to begin with,' Cubanski said. 'But it is designed to deal with price increases from one year to the next that have been rising faster than inflation.'

Will Medicare target Ozempic for discounts?

The Danish drugmaker Novo Nordisk has been scrutinized over the pricing of its diabetes drug Ozempic and weight-loss drug Wegovy.

The company’s top executive was called before the Senate Committee on Health, Education, Labor and Pensions last September to answer questions about the drug’s list price.

Novo Nordisk expects Ozempic, which has been on the market since 2017, will be on Medicare’s list of drugs to negotiate price concessions, Bloomberg reported. The company told USA TODAY that it would not discuss Medicare’s next round of negotiations because the list of selected drugs is not yet public.

Novo Nordisk spokesperson Jamie Bennett said several factors influence drug pricing, including inflation, market conditions, government and private insurer actions as well as drug-pricing middlemen called pharmacy benefit managers.

Pharmacy managers often demand rebates from drug companies in exchange for placement on health insurance formularies − the list of drugs an insurer will cover.

Bennett said 80% of patients with insurance pay $25 or less per month for Ozempic and 90% pay $50 or less.

'While the list price is set by Novo Nordisk, taken out of context it can be misleading,' Bennett said. 'The list price does not reflect the rebates, discounts and fees that Novo Nordisk provides to lower the list price, nor does it reflect the numerous other costs in the system that ultimately impact the price PBMs, health insurers or governments pay.'

'We really are seeing these remarkable price increases year after year. It’s so important to try to discourage drug companies from taking these regular price increases.'

Leigh Purvis

Prescription drug policy principal

at the AARP Public Policy Institute

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U.S. Sen. Bernie Sanders, I-Vt., chair of the Senate Health, Education, Labor and Pensions Committee, speaks during a hearing at which Novo Nordisk CEO Lars Jorgensen was asked about drug pricing. Piroschka Van De Wouw/REUTERS file

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01/09/2025

Week of January 6, 2025
This article provides general information and is not legal or tax advice. If you have specific questions
about compliance with the Affordable Care Act, please contact your legal counsel.
MEC and ALE Reporting Reminders and FAQs
The Affordable Care Act (ACA) added section 6055 to the Internal Revenue Code (IRC), which requires
health insurance issuers like BlueCross and self-funded health plans that provide minimum essential
coverage (MEC)1
to report information about enrollees to the Internal Revenue Service (IRS). The ACA
also added section 6056 to the IRC, which requires all applicable large employers (ALEs)2
to report
information about their employees to the IRS. In general, the information reported to the IRS is also
provided to subscribers and/or employees.
The following information is provided for general use and should not be considered legal or tax advice.
Employers and plan sponsors should direct specific questions to their legal counsel or tax professional.
The IRS webpage, Information Reporting by ALEs, may also be helpful.
2024 Forms and Instructions
The IRS updated Forms 1094 and 1095 and instructions for 2024. Issuers like BlueCross will report
information to the IRS about our insured group members using Forms 1094-B and 1095-B and their
instructions.
3 We will also provide Forms 1095-B to subscribers in compliance with IRS regulations.
ALEs report information to the IRS about their full-time employees and offers of health coverage using
Forms 1094-C, 1095-C, and their instructions. ALEs who sponsor self-funded plans that meet the
definition of MEC also report information about who was enrolled in coverage during 2024. The
employer is required to send Form 1095-C to each employee included in IRS reporting with their specific
information, including dependents enrolled under a self-funded plan if applicable.
Generally, ALEs file using Forms 1094-C and 1095-C. Most employers should NOT use Forms 1094-B or
1095-B. One exception is an employer that is not an ALE and offers a self-funded plan that meets the
definition of MEC, which may include employers with level-funded arrangements. In these cases, the
1 Generally, MEC includes eligible employer-sponsored health plans. It does not include coverage providing only
limited benefits, such as stand-alone vision and dental plans, workers' compensation coverage, and coverage
limited to a specified disease or illness. For more information, visit this IRS webpage.
2 Generally, an ALE is an employer that employed an average of at least 50 full-time employees (including full-time
equivalent employees) on business days during the preceding calendar year. Visit this IRS webpage for more
information including aggregation rules for related entities and exceptions for certain workers.
3 BlueCross will also report information about individual policyholders who are not enrolled through the
Marketplace on Form 1095-B; the Marketplace will report information about enrollees to the IRS on Form 1095-A.
plan sponsor (generally, the employer) is responsible for filing Forms 1094-B and 1095-B with the IRS
and furnishing Forms 1095-B to their employees.
The following chart shows who is responsible for completing and filing the forms based on the type of
coverage offered and an employer’s status as an ALE:
MEC and ALE Reporting Responsibilities
Employer Type Coverage Type
MEC Reporting (IRC Sec. 6055) ALE Reporting
(IRC Sec. 6056)
1094/1095-B 1094/1095-C 1094/1095-C
Not an ALE
Insured MEC BlueCross
Self-funded* MEC Plan Sponsor**
ALE
Insured MEC BlueCross Employer
Self-funded* MEC Employer (MEC + ALE on single form)
None Employer
*Includes level-funded arrangements **The plan sponsor is generally the employer
Filing Deadlines and Extension
The deadline for entities (filers) to file Forms 1095-B or 1095-C with the IRS for calendar year 2024 is
March 31, 2025, if filing electronically, or Feb. 28, 2025, if filing otherwise. Entities filing more than 10
forms are required to file electronically.
4
Filers may obtain an automatic extension of time for filing
with the IRS by submitting Form 8809.
A final rule issued on Dec. 22, 2022 (2022 final rule) provides an automatic extension to the deadline for
furnishing Form 1095-B to subscribers and Form 1095-C to employees. The general deadline is Jan. 31;
the extension is not to exceed 30 days from this date and is adjusted if the extended date falls on a
weekend or holiday. For calendar year 2024, the extended deadline to furnish Forms 1095-B or 1095-C is
March 3, 2025.
This extension is automatic and replaces previous regulations that permitted entities to request a 30-day
extension to furnish forms to individuals. The extension does not impact an entity’s responsibility to file
information with the IRS by the previously mentioned deadlines.
Alternative Manner for Furnishing Forms 1095-B to Individuals
The 2022 final rule also provides an alternative manner to furnish Forms 1095-B to individuals in years
when the individual shared responsibility payment (aka individual mandate penalty) is $0. The
alternative requires the entity responsible for furnishing the form to post information about requesting
a form on its website and provide forms within 30 days of receiving a request.
4 The electronic filing threshold for information returns required to be filed on or after January 1, 2024, has been
decreased to 10 or more returns. Previously, the threshold to require electronic filing was 250 returns.
The alternative is also available to ALEs for furnishing statements to non-full-time employees and nonemployees who are enrolled in the ALE’s self-insured group health plan, again only in years when the
individual shared responsibility payment is $0.
Historically, this option did not extend to Forms 1095-C that ALEs furnish to full-time employees,
including coverage information reported by self-funded plans in Part III of the form. However, the
Paperwork Burden Reduction Act, enacted on Dec. 23, 2024, permits similar flexibility for ALEs to
provide clear, conspicuous, and accessible notice (at such time and in such manner as prescribed by the
Secretary of the Treasury) and furnish Forms 1095-C to employees by the later of Jan. 31st or within 30
days of a request. The law applies to returns for calendar years after 2023, however, it’s not clear if the
Secretary will need to publish guidance or regulations regarding the notice requirement prior to
employers taking advantage of this new flexibility. Please refer to the law for more details.
Elimination of Good Faith Relief
Prior to the 2021 tax year, the IRS provided good faith relief from penalties due to missing and
inaccurate information reported on the forms, such as tax ID number and date of birth. Notice 2020-76,
issued in Oct. 2020, indicated that good faith relief would not be available for the 2021 tax year and
subsequent tax years. The preamble to the 2022 final rule reiterates that the good faith relief is no
longer available. The IRS believes the tax code already provides adequate relief from penalties for filers
who have reasonable cause for failing to timely or accurately complete their reporting requirements.
Frequently Asked Questions
Q1: Does BlueCross plan to provide 2024 Forms 1095-B on request only?
A: Yes. Similar to last year, we will include a link on our homepage in the “Forms” section where
subscribers can log into their BlueCross account and submit an e-form to request their Form 1095-B for
insured group or individual off-marketplace coverage. The link will go live by Jan. 31, 2025.
Subscribers can also call, email, or write us to request a form using the “contact us” information or
physical address included on the webpage. Forms will be mailed to a subscriber’s address on file within
30 days of receipt of the request.
We will automatically mail Forms 1095-B to subscribers who lived in certain states and had insured
medical coverage with us during 2024. Please see Q9 for more information.
Q2: Why is BlueCross making Form 1095-B available on request only?
A: Individuals currently do not need the information on Form 1095-B to prepare and file their federal tax
returns. Because of the reduced need for Form 1095-B, we anticipate few subscribers will request one.
This will in turn save costs, in both dollars and natural resources.
Q3: Will BlueCross furnish Form 1095-B for all subscribers of a group if an employer requests it?
A: At this time, we will accept subscriber-initiated requests only.
Q4: Will BlueCross make copies of Form 1095-B available to brokers and/or employers?
A: BlueCross is required to furnish Form 1095-B to a subscriber when requested. We do not plan to
make the forms available for brokers or employers currently.
Q5: Who can a subscriber call to ask questions about the information on their Form 1095-B?
A: We will include contact information on Form 1095-B. The subscriber may call the number on the form
if they have questions about the information included on it or need to make a correction. For questions
about how to file their taxes, subscribers should contact their tax professional.
Q6: How long does it take for BlueCross to issue a corrected Form 1095-B?
A: Corrections are typically made within 30 days of receipt of the corrected information, at which time a
subscriber will be able to request a corrected form using the process described in Q1.
Q7: If BlueCross files Form 1095-B for subscribers with insured coverage, does the employer also have
to file something?
A: If the employer is an ALE, the employer must file Forms 1094-C and 1095-C with the IRS and furnish
Forms 1095-C to employees. This filing is required even when BlueCross is filing Form 1095-B for the
subscribers in the employer’s insured medical plan. Employers should contact their legal counsel or tax
professional with additional questions about filing requirements.
Q8: Some states have imposed coverage mandates for their residents, including reporting
requirements. Will BlueCross file information with these states?
A: For 2024, California, New Jersey, Rhode Island, and Washington DC are requiring coverage reporting
based on the same information we file with the federal government on Form 1095-B. Because the
information is the same, we will be filing information with these states for any subscribers enrolled in an
insured group plan during 2024 for whom we also have a CA, NJ, RI, or DC address on file.
Massachusetts has had a coverage mandate in place since 2006, and it does not use Form 1095-B. We
do not file coverage information with MA for either insured or self-funded plans.
Plan sponsors should contact their legal counsel or tax professional to determine if they have an
obligation to file information in states that have adopted coverage mandates.
Q9: In states with coverage mandates, will residents have to request a Form 1095-B from BlueCross?
A: Generally, no. Using the home address we have on file, if our records show that a member lived in
California, Maryland, New Jersey, Rhode Island, Vermont, or Washington DC at any time during 2024
and was enrolled in insured group coverage, we will mail a Form 1095-B automatically. The subscriber
does not need to make a request. We plan to mail the forms by Jan. 31, 2025, to applicable subscribers
using the current mailing address we have on file.
Massachusetts has a coverage mandate that predates the ACA and does not use Form 1095-B. We will
continue our practice and mail a letter to insured and self-funded group members who had medical
coverage and lived in MA at any time during 2024. The letter indicates the months the member was
covered by their employer’s plan. This letter is not the same as Form MA 1099-HC. We do not create or
furnish Form MA 1099-HC.
Plan sponsors should contact their legal counsel or tax professional to determine if they have an
obligation to furnish information to employees in states that have adopted coverage mandates.
Q10: Does BlueCross have any resources to assist self-funded and level-funded plans with their filing?
A: Yes. A free report is available that may help self-funded and level-funded groups with the filing if they
believe it meets their needs. After logging into our secure website and selecting Interactive Reports, the
report can be found under Membership > Combined Membership > Group Member Listing by Year.
The report will display each member that had active medical coverage in BlueCross’s system at any point
during the calendar year selected and indicate each month the person was covered, along with other
information such as the member ID, birth date, and social security number, if available. If a member was
enrolled for medical coverage for one day out of a month, the report will indicate that the member was
covered for that month. If a member does not have a termination date loaded in the system that occurs
before the end of the selected year, the coverage end date will default to December 31.
The reported information is based on processed transactions as of the last data load date indicated in
the report heading; data will change as additional transactions are processed. The underlying database
is updated monthly, typically a few days after the end of the month.
Use of this information is at the employer’s discretion and should not be considered legal or tax advice.
BlueCross does not guarantee the accuracy of the information. Protected Health Information (PHI) and
Personally Identifiable Information (PII) included on the report must be kept confidential and
safeguarded in compliance with HIPAA and other applicable privacy laws and regulations.
Q11: Can BlueCross complete the filing for ALEs?
A: BlueCross doesn’t have the information necessary to complete the filing for ALEs. The ALE filing
requires employers to identify their full-time employees during the calendar year and if full-time
employees were offered affordable, minimum essential coverage. This is not information we have.
Thomson Reuters, a global leader in providing automated tax/information reporting solutions, may be
an option for employers. Thomson Reuters gives a 10% discount to BlueCross customers, and their
ONESOURCETM solution can help with:
• Managing print and distribution of 1095-C forms to employees
• Electronic filing of 1095-C and 1094-C information through the IRS AIR system format
• Help reconciling, validating and managing errors
Please ask your BlueCross Sales or Account Executive for more information

12/15/2024

These are the coolest book totes we got in today. They come with the signature library card from New York.