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Individual Coverage HRAs promote healthcare choice and competition and make it easier to offer valued benefit


Image of stethoscope on U.S. flag and medical record; representing medical costs in the United States.

Expanded availability of HRAs promotes healthcare choice and competition

President Trump has promised Americans that he will put them in control of their healthcare, and this expansion of health reimbursement arrangements will help deliver on that promise by providing Americans with more options that better meet their needs.

One of the biggest challenges that small employers face is attracting and retaining employees. Beginning January 1, 2020, employers who have multiple employees can offer an Individual Coverage Health Reimbursement Arrangement (ICHRA) to employees to reimburse individual insurance premiums and out-of-pocket medical expenses. These changes will make it easier for employers to provide a valuable benefit. This policy is a result of Executive Order 13813. This order was issued by President Trump in 2017 to expand the availability and use of Health Reimbursement Arrangements (HRAs) and promote healthcare choice and competition.

HRAs are employer-sponsored and -funded health plans used to reimburse employees for medical expenses on a tax-free basis. It’s estimated this expansion of HRAs will benefit approximately 800,000 employers. This number includes small businesses, which comprise more than 11 million employees and family members, including an estimated 800,000 Americans who were previously uninsured.

According to HHS Secretary Alex Azar, “President Trump has promised Americans that he will put them in control of their healthcare, and this expansion of health reimbursement arrangements will help deliver on that promise by providing Americans with more options that better meet their needs.”

Some highlights of the legislation and ICHRA features:


  • Any employer can offer an ICHRA. There are no size restrictions and no minimum participation requirements.
  • Employees can use employer-funded ICHRAs to buy individual insurance coverage, including insurance purchased on the public exchange.
  • Offering an ICHRA counts as an offer of coverage under the employer mandate.
  • Employers who sponsor Group insurance may also offer an ICHRA to employees who have elected not to participate in the Group insurance plan.
  • Multiple classes are allowed. This gives employers flexibility to offer different amounts based on such criteria as full- versus part-time employment, salaried versus hourly employees, geographic location, and more.
  • HRAs are solely funded by an employer; they are employer-sponsored and reimbursed benefits.
  • An employer who sponsors an ICHRA plan will be able to enhance this offering with additional benefits—such as Individual insurance premiums, healthcare FSA, dependent care, and Health Savings Account on a pre-tax basis.
  • HRAs are not pre-funded and must be based on a calendar year.

ICHRAs will allow small employers to overcome many of the limitations of previous HRA offerings as described below:

IRS Notice 2013-54, issued in September 2013, limited the ability of small business owners to utilize stand-alone HRAs. Prior to this guidance, many had used HRAs to reimburse their employees for certain medical expenses using pre-tax dollars. As a result of IRS Notice 2013-54, a company with more than one eligible employee could no longer receive a tax advantage through an HRA unless it sponsored Group insurance (an expense that’s beyond many small companies’ reach) —or offered a Limited Purpose HRA (which can only provide coverage for dental, orthodontia, vision and long-term care).

In 2016, the Cures Act established the Qualified Small Employer HRA (QSEHRA). This legislation overturned guidance issued in IRS Notice 2013-54 and once again allowed employers with fewer than 50 employees (companies not subject to the ACA’s Employer Mandate) to utilize HRAs as a pre-tax health and welfare benefit. The QSEHRA has many restrictions and requirements that the ICHRA does not. For example, a QSEHRA is only available to employers with fewer than 50 eligible employees and employer contributions are capped.

About TASC:

TASC is an award-winning, national third-party benefits administrator of tax-advantaged health benefits plans. The company offers comprehensive services for clients, participants, and Providers and serves companies ranging in size from one employee to thousands. TASC has created a simple, intuitive way to manage benefits: Universal Benefit Account. This revolutionary service is designed around how people think, rather than overcomplicated rules, and helps employers work smarter and faster.

AgriPlan and BizPlan (Section 105 HRAs) are products that fall under TASC’s Microbusiness umbrella. AgriPlan and BizPlan save small business owners an average of more than $5,800 a year on their insurance premiums and out-of-pocket medical expenses.

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Separating from Your Employer without the Drama”


“Breaking Up is Hard to Do: Separating from Your Employer without the Drama”

“Breaking Up is Hard to Do: Separating from Your Employer without the Drama”

This webinar will provide valuable information for physicians who may wish to separate from an employer either now or in the future.

Physicians’ Reciprocal Insurers (PRI), a New York State medical malpractice insurer, is pleased to announce an upcoming webinar on “Breaking Up is Hard to Do: Separating from Your Employer without the Drama”.

Presented in partnership with Frier Levitt, a national healthcare law firm, this webinar will provide valuable information for physicians who may wish to separate from an employer either now or in the future. Knowing what to expect and understanding the legal ramifications of employment contracts can provide insights and practical advice to minimize the impact on your business.

The webinar will be hosted by John E. Morrone, Esq., a Partner with the law firm. Mr. Morrone’s focus at the practice is on transactional and regulatory healthcare law. He writes and speaks extensively on healthcare legal matters and is a regular source of information for news outlets on healthcare topics, such as Bloomberg Business. In this webinar, he will discuss exiting employment contracts and re-entering private practice with minimal disruption. The webinar will include discussions on:

  • Legal implications of exiting employment contracts
  • Escaping the non-compete
  • Managing non-solicitation provisions
  • Preserving the physician-patient relationship
  • How to avoid common missteps and minimize the impact on your business

This free webinar will take place on Thursday, November 14, from 2-3 p.m. To register for this event please use this Registration Link. For additional information, please contact Katherine E. Guglielmo, Marketing Coordinator at (973) 618-1660, email: kguglielmo@frierlevitt.com.

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NightDragon Security Announces Expansion of its Team and Advisory Council


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The deep operating backgrounds of these additions will enable us to build great teams, form powerful go-to-market models, and deliver strategic outcomes for the entrepreneurs we work with.

NightDragon Security, a dedicated cybersecurity investment firm, today announced the addition of Morgan Kyauk as Managing Director and the appointment of Jason Martin of FireEye, Dan Burns of Optiv, Matthew Gyde of NTT Security, and Andrew Howard of Kudelski Security to its advisory council.

Morgan is the former Vice President of Corporate Development at FireEye, where he was responsible for the evaluation, execution, and integration of all acquisition, investment, and strategic partnering activity for the company. Morgan worked with fellow NightDragon Managing Directors, Dave and Ken, to drive corporate development efforts at FireEye, leading up to the company’s IPO and through its transformative acquisitions. Morgan has also held corporate development leadership roles at a variety of companies within the enterprise software, infrastructure, and security sectors, including Dropbox, Juniper Networks, and HP. Morgan will be working with Dave and Ken on identifying and collaborating with entrepreneurs to grow the next generation of leading cybersecurity companies.

Jason is a seasoned technology executive and entrepreneur with over twenty years of cyber security experience. Jason is currently an Executive Vice President at FireEye where he has served in leadership roles in product management, R&D, engineering, and cloud operations. Prior to FireEye, he was President and CEO of SecureDNA (acquired by FireEye) which provided innovative security products and solutions to enterprises and government agencies throughout the United States and Asia. Jason also served as Chairman of Authy.com (acquired by Twilio) and currently sits on the advisory board for OneMedNet and the Board of Directors for ShieldX. Jason has also co-authored several books covering various cyber security domains and is co-founder of the ShakaCon security conference, which is focused on increasing knowledge sharing and collaboration within the security community.

Dan is the CEO of Optiv Security, which was created in 2015 as a result of the Accuvant and FishNet Security merger. From 2002, when he co-founded Accuvant, until 2012 when he assumed his position as the company’s first CEO, Dan served as Senior Vice President of Accuvant’s sales organization. In that role, he was responsible for strategic planning, sales growth, and problem resolution. Dan co-developed and helped to successfully execute on Accuvant’s initial vision – to build a company with the breadth, depth, and capabilities to address the information security needs of organizations worldwide – up until the merger with FishNet Security.

Matthew is the CEO of NTT Security, formerly known as Dimension Data’s Security Business Unit. Matthew is responsible for executing the organization’s security strategy, services and go-to-market strategy with the goal of building the world’s most recognized security brand supported by a team of highly talented security professionals. Matthew previously held the position of Group Executive of Security for Dimension Data. He held several roles during his tenure with Dimension Data. Prior to this, Matthew spent time in various security environments, from a client to a carrier to OEMs across Australia, Asia, and now global positions.

Andrew is the CEO of Kudelski Security, an independent Swiss provider of tailored cyber security solutions to enterprises and public sector institutions, with its U.S. headquarters in Phoenix, Arizona. Andrew has led the company’s technical strategy, product development, engineering and research, notably the launch of the IoT Security Center of Excellence, the delivery of Secure Blueprint, and the Blockchain Security Center. Previously, Andrew led an R&D laboratory focused on national defense challenges for the Georgia Tech Research Institute.

“Morgan’s corporate development experience and Jason’s product and technical vision will be immensely valuable for NightDragon companies. In addition, Dan, Matthew, and Andrew bring strong relationships that can provide a source for go-to-market scale and early insights of customer pain points,” said Dave DeWalt, Managing Director at NightDragon. The deep operating backgrounds of these additions will enable us to build great teams, form powerful go-to-market models, and deliver strategic outcomes for the entrepreneurs we work with.”

ABOUT NIGHTDRAGON SECURITY

NightDragon Security is an investment firm focused on investing in growth and late-stage companies within the cybersecurity industry. Its flexible model allows it to lead or co-invest alongside leading venture capital and private equity firms in the pursuit of driving growth and increasing shareholder value. NightDragon is unique in providing deep operational expertise in cybersecurity gained by its founders Dave DeWalt and Ken Gonzalez from years serving as senior executives leading technology companies such as Documentum, EMC, Siebel Systems (Oracle), McAfee, Mandiant, Avast, and FireEye.

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Greenberg Traurig’s Ruth Bahe-Jachna to Receive Illinois Lawyer’s Assistance Program Award


Ruth A. Bahe-Jachna, a shareholder in the Chicago office of global law firm Greenberg Traurig, LLP, will receive the Illinois Lawyers’ Assistance Program’s (LAP) Executive Director’s Award at the Program’s Annual Dinner, Nov. 14.

The LAP is a not-for-profit organization that helps Illinois lawyers, judges, law students, and their families concerned about alcohol abuse, drug dependency, or stress related issues like anxiety, burnout, depression, and many others. The Executive Director’s Award is presented to an individual who significantly contributed to the goals and mission of LAP and supported the executive director in her role, according to the organization.

Bahe-Jachna has more than 30 years of experience working on and managing large-scale litigation matters. She regularly defends clients in class actions and product liability and consumer fraud litigation in state and federal courts, as well as in employment-related class actions and FLSA collective actions. She regularly counsels clients on a wide variety of product safety and risk management matters, including providing guidance on U.S. Consumer Product Safety Commission (CPSC) reporting requirements, recall issues and appropriate recall processes, and drafting release and waiver forms, warning labels, and warranties. An active member of the American Bar Association, Bahe-Jachna recently served as co-chair of the ABA Litigation Section’s Attorney Mental Health & Wellness Task Force, and continues to work with that Task Force in an advisory capacity.

About Greenberg Traurig: Greenberg Traurig, LLP (GT) has approximately 2100 attorneys in 41 locations in the United States, Latin America, Europe, Asia, and the Middle East. GT has been recognized for its philanthropic giving, diversity, and innovation, and is consistently among the largest firms in the U.S. on the Law360 400 and among the Top 20 on the Am Law Global 100. Web: http://www.gtlaw.com Twitter: @GT_Law.

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Aquicore Moves To New Headquarters in Downtown Washington D.C. to Accommodate Growth, Attract Top Talent and Give Back To The Community


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“We’re excited to be in a space that reflects our commitment to our employees and our dedication to building upon a best-in-class product that solves challenges facing the commercial real estate market in 2020 and beyond,” said Logan Soya, founder and CEO of Aquicore.

Aquicore, a leading commercial real estate software company with an all-in-one operations platform, today announced the opening of its new headquarters in the heart of downtown Washington, D.C. at 401 9th Street NW. On the coattails of Aquicore’s recent acquisition of Florida-based Entic, a fellow best-in-class proptech company, the new 16,710 square-foot headquarters enables Aquicore to continue to innovate and grow through existing and new partnerships, clients and employees.

By tripling the size of its office space in DC, Aquicore now comfortably houses its remote staff, Florida-based team and the D.C. team all at once. Aligning with its 2020 goal to grow its product team, Aquicore remains committed to equipping commercial asset managers and their teams with advanced, innovative, modern day solutions to make buildings more healthy, sustainable, productive and profitable long-term. To further solidify its reputation as the leading commercial real estate operations and performance optimization platform in the U.S., the new office in Penn Quarter will help attract and retain top talent to propel its cutting-edge solutions forward. Over the next two years, Aquicore plans to hire aggressively and is focused on nurturing local talent.

“This was a monumental year for Aquicore; our new office will provide the space and atmosphere we need to scale,” said Logan Soya, founder and CEO of Aquicore, “We’re excited to be in a space that reflects our commitment to our employees and our dedication to building upon a best-in-class product that solves challenges facing the commercial real estate market in 2020 and beyond.”

The newly renovated Aquicore headquarters offers state-of-the-art amenities, such as nitro cold brew on-tap, standing desks, video and board games, a Sweetgreen outpost, beer kegs, bi-weekly catered lunches and a fitness center complete with Peloton bikes and personal trainers. The office was designed to promote collaboration and idea sharing. It incorporates informal breakout spaces with conference rooms, a dedicated event space and an expanded IoT innovation lab. Aquicore plans to partner with local non-profit organizations across D.C. to host STEM programs for women and networking events to support, catalyze and promote D.C.’s accelerant technology scene.

To learn more about Aquicore, its new headquarters or available career opportunities, visit: http://www.aquicore.com.

About Aquicore:

Aquicore is a leading commercial real estate software company with an all-in-one asset operations and management platform. Its cloud-based platform enables commercial real estate owners and operators to improve building performance and team operations through data centralization, operational Intelligence and machine learning analytics. The only industry player to be built from the ground up as a portfolio-wide solution, Aquicore equips principals, property managers, building engineers and accounting teams with built-in communication tools, on-demand reporting and self-installable IoT sensors that can be deployed in a matter of days – instead of months. With key advanced features such as Utility Load Analysis, Utility Bill Management, Tenant Billing and HVAC Analytics, building teams can better track, monitor, analyze and predict key building performance factors in real time to unlock portfolio-grade insights, streamline business operations, increase property value and drive profitability. The Aquicore platform is currently deployed at more than 790 commercial buildings nationwide, optimizing more than 250 million square feet of corporate real estate space. For more information, visit http://www.aquicore.com and follow on Twitter @Aquicore.

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For the sixth consecutive year, Garavel Subaru of Norwalk selects Mikey’s Way Foundation as their Share the Love Event hometown charity


Paul and Jeremy Garavel of Garavel Subaru on a Mikey's Way Day at Yale New Haven Children's Hospital

Paul and Jeremy Garavel of Garavel Subaru on a Mikey’s Way Day at Yale New Haven Children’s Hospital

“Garavel Subaru has taken their philosophy of giving and put it into action to help the most vulnerable among us.”-Les Friedman, CEO of Mikey’s Way Foundation

Garavel Subaru of Norwalk has once again chosen Mikey’s Way Foundation to be the hometown charity recipient for their annual Share the Love Event. From November 15, 2019 to January 2, 2020, Subaru of America will donate $250 for every new Subaru vehicle purchased or leased at Garavel Subaru in Norwalk. In addition, every time Mikey’s Way Foundation is chosen as the charity of choice, Garavel Subaru will donate an additional $100 to Mikey’s Way for each sold or leased vehicle.

Since 2014, Garavel’s Share The Love Event has raised close to $200,000 for Mikey’s Way Foundation. That translates into more than 1,000 brand new electronic gifts such as laptop computers and tablets for pediatric cancer patients in treatment. In addition, Mikey’s Way was able to outfit each in-patient pediatric hematology/oncology room at Yale New Haven Children’s Hospital with an iPad for use during prolonged stays.

“We believe people will be remembered for what they do in the community, not for their individual accomplishments,” says Paul Garavel, President and owner of Garavel Subaru. “We are delighted to be partnering with Mikey’s Way once again this year, working to ease the strain of long-term treatment for pediatric cancer patients and their families.”

“We are honored and humbled to be chosen once again this year as the hometown charity for Garavel Subaru’s Share the Love event,” says Les Friedman, CEO of Mikey’s Way Foundation. “The Subaru organization, and Garavel Subaru in particular, genuinely cares about the people in need in our community. They’ve taken their philosophy of giving and put it into action to help the most vulnerable among us – and we are so grateful.”

Mikey’s Way Foundation was founded by Michael “Mikey” Friedman, who was diagnosed at 15 with a rare form of cancer. The Foundation gives laptop computers, tablets, and other Wi-Fi ready electronics to kids affected by the emotional and physical hardships of long-term debilitating treatment. They distribute these electronic gifts via their Mikey’s Way Day and Mikey’s Wish List programs to children all over the country with an emphasis in Connecticut and New York. The gifts provide diversion and connection with family and friends, helping them to cope with cancer… Mikey’s Way.

Garavel Subaru is located at 10 Tindall Avenue in Norwalk, CT. Everyday Garavel Subaru holds true to their motto: “Selling cars is what we do. Helping the community is who we are.” For more information about Garavel Subaru visit http://www.garavelsubaru.com.

For more information about Mikey’s Way Foundation, visit http://www.mikeysway.org and follow Mikey’s Way on Twitter, Instagram and Facebook.

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MedMark Treatment Centers Opens Milford, Ohio Medication-Assisted Treatment Facility Serving Clermont and Hamilton Counties


“MedMark can help those struggling with opioid addiction in these areas of significant need throughout Ohio. Our goal is to bring hope back to these patients and their families.”

MedMark Treatment Centers, a BayMark Health Services company, announced the opening of a new medication-assisted treatment (MAT) facility in the Cincinnati, OH suburb of Milford. MedMark Milford provides proven treatment for adults struggling with opioid addiction including medication, counseling and support services. The clinic, located at 749C State Route 28 in Milford, is now accepting patients.

“In 2017, of the 4,300 opioid-related deaths in Ohio, 488 were reported in Hamilton and Clermont Counties,” said Frank Baumann, COO of BayMark Health Services. “Medication-assisted treatment with substance use counseling provides patients with the best chance for sustained recovery from their addiction and the opportunity to reclaim their lives. MedMark can help those struggling with opioid addiction in these areas of significant need throughout Ohio. Our goal is to bring hope back to these patients and their families.”

MedMark Treatment Centers are known across the country as leading providers of high-quality, proven treatment for opioid use disorder utilizing treatment medications including methadone and buprenorphine. MedMark programs support the use of MAT with addiction counseling and education, relapse prevention, lab testing, coordinated care for pregnancy and linkages to community resources to assist patients in achieving long-term recovery. MedMark Milford is the fourth program BayMark has opened in Ohio in 2019 under the MedMark Treatment Centers service brand. Our mission is to provide comprehensive medication-assisted treatment for opioid use disorder and other health care services to foster wellness, longevity and socially responsible behavior for the patients we serve.

David K. White, Ph.D., Chief Executive Officer, noted, “As the leader in providing specialized treatment for opioid use disorder, BayMark Health Services understands that patients benefit from access to a variety of proven treatment methods that meet them where they are at in their recovery journey. There is tremendous need across the country, but very few places have experienced devastation to the extent that they have in Ohio. BayMark has responded to that need by offering traditional structured medication-assisted treatment through our MedMark Treatment Services brand along with inpatient withdrawal management services by our New Vision brand and outpatient Suboxone® treatment through our AppleGate Recovery brand in Ohio.”

For more information on MedMark Milford and our services visit: http://MedMark.com or for admissions contact Meleah Naylor, Treatment Center Director, at 513.214.2094.

About BayMark Health Services:

BayMark Health Services provides medication-assisted treatment to 53,000+ patients in recovery from substance use disorder across the United States and Ontario, Canada. Our outpatient programs deliver medically-supervised treatment, in a variety of modalities and settings, to meet the diverse needs of our patients who struggle with the use of opioids, alcohol and other prescription and illicit substances. The BayMark continuum of patient-focused services includes: highly structured opioid treatment programs utilizing methadone or buprenorphine and outpatient buprenorphine treatment programs, both of which incorporate counseling as part of an individualized treatment plan for opioid use disorder. Additionally, ambulatory withdrawal management services with naltrexone therapy, and inpatient detoxification services are offered for a variety of substance use disorders.

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Alera Group Acquires Capital Region Benefits


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The collaboration between Capital Regions and AIA is already well established. We look forward to these two firms continuing to grow together.

Alera Group, a national employee benefits, property and casualty, risk management and wealth management firm, today announced that it has acquired Capital Region Benefits, effective November 1, 2019.

Capital Region Benefits, an independent insurance agency located in Camp Hill, Pennsylvania, has provided group benefit insurance services to Central Pennsylvania employers since 2004. Capital Region Benefits also provides health reimbursement arrangement (HRA) and COBRA administrative services to both employers and other broker partners and is the national third-party administrator for VBA, a Pittsburgh-based non-profit vision preferred provider organization that delivers cost contained group vision benefits.

“We are excited to welcome the Capital Region Benefits team, led by Diane Barber, to Alera Group,” said Alan Levitz, CEO of Alera Group. “The collaboration between Capital Regions and AIA is already well established. We look forward to these two firms continuing to grow together.”

“As an Alera Group company, we look forward to providing more tailored resources and tools to our clients as part of their benefit plans,” said Diane Barber, President of Capital Region Benefits. “The combination of Alera Group’s national scope and our powerful local relationships positions us for continued growth and success.”

Capital Region Benefits joins Alera Group through AIA, Alera Group. The Capital Region Benefits employees will continue serving clients in their current roles. Terms of the transaction were not disclosed.

About Alera Group

Based in Deerfield, IL, Alera Group’s over 1,800 employees serve thousands of clients nationally in employee benefits, property and casualty, risk management and wealth management. Alera Group is one of the 20 largest independent insurance agencies in the country. For more information, visit http://www.aleragroup.com or follow Alera Group on Twitter: @AleraGroupUS.

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MineralTree CEO to Join Other Fintech Thought Leaders at Citi Financial Technology Conference to Speak on Automating Business Payments


“The digitization of B2B payments and the full end-to-end AP process is a critical focus area that business leaders will need to embrace in order to fully optimize their back-office procedures.”

MineralTree, a market-leading Accounts Payable and Payment Automation solution provider, has announced its CEO, Micah Remley, will speak on a panel at the Citi Financial Technology Conference taking place in New York City, November 12-13, 2019. Speaking alongside Remley on the panel will be Rob Eberle, president and CEO of Bottomline Technologies (EPAY).

The session “Business Payments Digitization and AP Automation” will explore the complexity of business payments and how AP automation solution providers are helping businesses streamline a very manual, inefficient and tedious process.

“This year’s Citi’s Financial Technology Conference has a great roster of fintech companies with innovative strategies that are charting the future for the industry,” said Micah Remley, CEO of MineralTree. “The digitization of B2B payments and the full end-to-end AP process is a critical focus area that business leaders will need to embrace in order to fully optimize their back-office procedures.”

The digitization of business payments and associated AP workflows represents a huge opportunity for businesses to cut costs, reduce fraud risk and maximize working capital. Over 1,500 middle market businesses are doing this leveraging the MineralTree platform to automate the B2B payments process.

About MineralTree

MineralTree provides the easiest to use Accounts Payable (AP) and Payment Automation solutions for finance professionals at middle market enterprises. MineralTree streamlines AP, giving customers unparalleled visibility and significant cost savings in an affordable, integrated platform that is guaranteed secure. For more information, visit http://www.mineraltree.com.

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Opioid-dependent baby suits go forward with amended suits linking in-utero drug exposure to birth defects according to Opioid Justice Team experts


Four of the 34 statewide class actions pending before Judge Dan Polster’s Multi-District Litigation have been amended with evidence pleading the causal connection between in-utero prescription opioid use and birth defects in exposed fetuses, said Lead Counsel Scott Bickford.

“For the first time, the dirty secret regarding prescription opioids prescribed to women of child-bearing age is revealed,” said Legal Strategist Stuart Smith. “Our research shows that though the federal agencies documented the link between in-utero exposure to prescription opioids and birth defects, a timely black box warning on opioid prescriptions given to women by their doctors and gynecologists could have and should have been made before 2014, when the first warning in opioid labeling was made.”

These cases now present a legal model for replication in all cases, Mr. Bickford said. The suits were filed seeking to protect the rights of babies born opioid-dependent and their guardians because these children will face life-time medical needs related to educational, physical, and developmental disabilities.

“The responsible parties who should have warned prescribers of opioids to women of childbearing age, never undertook a Risk Evaluation and Mitigation Strategy (REMS) similar to other proven teratogens,” said Mr. Bickford. “These cases are an important public warning to women and their babies because they were left unprotected during decades of widespread distribution, marketing and medical use of these drugs.”

The four amended cases in West Virginia, California, Tennessee and Ohio document the birth defects and complications children born before 2014 to mothers using prescription opioids are now facing, along with the scientific links alleging the mechanism of action by which this class of prescription opioid drugs caused these debilitating injuries.

The amended briefs include research conducted by Toxicological Pathologist Dr. Vyvyan Howard of Ulster University and Neo-Natal Abstinence Syndrome (NAS) Expert Dr. Kanwaljeet Anand of Stanford University. The teratogenic effects of opioids on a developing fetus range from physical deformities such as heart, brain and gastroenterological defects, including mal-formed heads, cleft palates or lack of complete bowel systems, as well as neurological, motor and cognitive defects such as inability to walk, talk or complete basic skills.

“The hard work of these independent researchers has uncovered the sorry details of this public health crisis, but we remain concerned that these facts will get lost in the fights over bankruptcies and counter lawsuits,” said Mr. Bickford. “This information must get out to every doctor and pharmacy, and a REMS program instituted to protect every woman of child-bearing age who might be prescribed these risky drugs.

“Hundreds of thousands of Opioid Dependent Children have been born in the last 20 years. These children face educational and developmental hurdles, and many may face future addiction since they were born addicted. We continue to push aggressively in the federal court system and before Judge Polster presiding over the Multi-District Litigation for a specific NAS track because of the severe and enduring impact this epidemic has and will have on our nation’s children.

Table 1 shows the association between maternal opioid analgesic treatment and specific major birth defects in National Birth Defects Prevention Study of 17449 cases and 6701 controls. Significance is starred * in the usual way. Odds ratios were adjusted for maternal age, race/ethnicity, education, pre-pregnancy obesity, smoking.

“The lawsuits seek creation of a medical monitoring trust fund for these children funded by the prescription drug defendants directly, rather than relying on local governments with competing priorities,” Mr. Bickford said, illustrating the gravity of the situation by estimating that an opioid-dependent child is being born every 15 minutes in the United States.

Statistics compiled by the Centers for Disease Control estimate that first-year Medicaid costs for opioid-exposed infants average approximately $238,000 and the additional cost burden on hospital Neo-natal Intensive Care Units has increased five-fold in less than a decade.

“These estimates do not cover costs borne by family caregivers or foster-care institutions responsible for the infants once released from the hospital. The guardians and parents who take these infants home frequently believe that once the child is weaned from their opioid-dependency, there will be no long-term impact on the child. Data shows that is unfortunately almost never the case,” said Mr. Bickford.

The 34 states represented in the NAS legal filings are:

Alabama, Arkansas, Arizona, California, Colorado, Delaware, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin.

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