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Health & Welfare Plans Newsletter December 12, 2019 |
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Webcasts, Conferences Communicating Employee Benefits and Compensation Symposium
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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Solicitor General Weighs in on ERISA Preemption Battle Over State PBM Statutes "At issue ... is whether an Arkansas statute that regulates the rates charged by Pharmacy Benefit Managers (PBMs), is preempted by [ERISA].... The Eighth Circuit Court of Appeals ... held that the Arkansas law included PBMs that cover ERISA plans, so the law 'relate[d] to and has a connection with employee benefit plans,' and was therefore preempted, declaring the law unenforceable as applied to PBMs in their administration and management of an ERISA plan.... The Solicitor General's brief argues that the [Eighth Circuit] erred in holding ERISA preemption under both the 'reference to' and 'connection with' theories of preemption." [Pharmaceutical Care Mgmt. Assoc. v. Rutledge, Nos. 17-1609 and 17-1629 (8th Cir. June 8, 2018; cert. pet. filed Oct. 22, 2018)] Morgan Lewis via Mondaq |
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Update on Prescription Drug Legislation in Congress "In the House of Representatives, the Democratic caucus is expected to pass HR 3 ... which contains a series of far-reaching drug pricing reforms. At the same time, the House Republican caucus introduced its own drug pricing bill [see summary and text], largely composed of smaller bipartisan elements. In the Senate, the Finance Committee released updates to its drug pricing package [see news summary and text], and the Health, Education, Labor, and Pensions (HELP) Committee reached a deal on surprise billing that includes a range of small bipartisan drug pricing elements [see summary]." Health Affairs |
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Ten Charts on Proposals to Lower Prescription Drug Costs "A primer on prescription drug proposals introduced by the Senate Finance Committee, House Democrats and Republicans, and the Trump Administration." Henry J. Kaiser Family Foundation |
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Justices Appear Sympathetic to Insurers in Risk Corridor Payment Oral Arguments "The Justices seemed troubled by the government's position that Congress rarely enacts a money-mandating statute in the absence of an explicit appropriation. Chief Justice John Roberts, for instance, asked why an instruction from Congress directing an agency to pay a private party is insufficient to give rise to an obligation.... Justice Breyer used an extended analogy to compare the risk corridors program to a contractual obligation. Justice Samuel Alito appeared the most skeptical of the insurers' arguments, raising questions about whether the insurers had a cause of action and whether damages were available." [Maine Community Health Options v. U.S., No. 2017-2395 (Fed. Cir. Jul. 9, 2018; cert. granted Jun. 24, 2019; oral arg. Dec. 10, 2019)] Katie Keith, in Health Affairs |
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Managing Health Plan Costs After the Removal of Annual and Lifetime Limits "Plan sponsors and their health plan administrators are actively seeking solutions to finance the high price of these therapies. Those developed so far include: [1] Installment payments to spread the cost of expensive therapies over multiple years. [2] Risk pooling with multiple plans.... [3] [P]rograms that would cover gene therapies that cost above a certain threshold for a per member per month fee. [4] Outcomes-based pricing, which would tie ultimate reimbursement to the clinical effectiveness of therapies." International Foundation of Employee Benefit Plans [IFEBP] |
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Benefits in General |
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DOL Restores Over $2.5 Billion to Employee Benefit Plans and Participants During FY2019 "EBSA's enforcement and benefit advisor programs recovered over $2.5 billion in payments to plans, participants and beneficiaries. EBSA's enforcement program reported over $2 billion in recoveries from its investigations. Under its Terminated Vested Participant Project, EBSA helped participants collect nearly $1.5 billion in retirement benefits owed to them in the form of lump sum payments, present value of lifetime annuity payments and interest. EBSA's criminal investigations led to the indictment of 76 individuals -- including plan officials, corporate officers, and service providers -- for offenses related to employee benefit plans." [Also available: Fact Sheet -- EBSA 2019 Program Results] Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL] |
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Selected Discussions |
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Same Dental Benefit But Employer-Sponsored for Some, Voluntary for Others "Dental benefit is provided for management, under 100 persons. It is offered as a fully voluntary benefit for staff. So total covered persons are over 100. I'm trying to figure out if this makes it an ERISA-covered benefit, among other things requiring a Form 5500 be filed." BenefitsLink Message Boards |
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Press Releases |
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Most Popular Items in the Previous Issue |
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Wellness Plan Compliance Checklist (PDF)
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HSA Planning When Both Spouses Have High-Deductible Health Plans
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The Answer for Gene Therapy Costs?
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