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Healthcare Law Blog

Broker Compensation and Monoclonal Antibodies

October 6, 2021

For more information about this blog post, please contact Khaled J. KleleRyan M. MageeLabinot Alexander Berlajolli, or Connor Breza.

Broker and Agent Compensation Proposed Rule

The Department of Health and Human Services (“HHS”) recently issued a proposed rule, 86 FR 51730, to promote transparency in agent and broker compensation. The proposed rule seeks to require issuers offering individual health insurance coverage or short term limited duration insurance to disclose to policyholders, before finalizing plan selection and on documentation confirming the individual’s enrollment, commission rates and compensation structure for other direct and indirect compensation provided by the issuer to an agent or broker associated with enrolling the individuals. The proposed rule would also require such issuers to report to HHS the actual, total amount of direct and indirect compensation paid by the issuer to the agent and broker for the preceding year. Comments are due by October 18, 2021.

HHS Assumes Monoclonal Antibody Distribution Responsibilities

Monoclonal antibody treatments have proven to be particularly effective in combating COVID-19 when implemented at early symptomatic stages. As a result, demand for the treatment is surging. But earlier this month, HHS took control over distribution of monoclonal antibody treatments across the U.S., pairing its policy change with the purchase of 1.4 million additional doses at a cost of $2,100 per dose.

Some states allege that HHS’s involvement in the distribution process will result in a shortage of treatments to those states that need it most. For example, in recent weeks, seven states – Alabama, Florida, Texas, Mississippi, Tennessee, Georgia, and Louisiana – have been using 70% of the monoclonal antibody treatments available nationwide. HHS’s policy change aims to change that statistic with a more equitable distribution across states.

HHS has stated that it will determine the amount of medication each state and territory receives on a weekly basis after examining relevant data, including hospitalization statistics and case rates. Under this new distribution model, HHS will determine each state’s weekly amount of monoclonal antibody products based on cases and use on a week-by-week basis. Healthcare providers will be required to record their utilization of the products promptly in order to be eligible to receive additional shipments.

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