"[P]roviders offering applicable items and services will need to quickly familiarize themselves with the mechanics and intricacies of navigating the IDR Process. This preparation should including getting comfortable with the IDR Process's procedural formalities, its rapid timeline, and the scope (and limitation) of discretion available to IDR Process arbitrators[.]"  MORE >>

"Plan participants must be made aware of key information.... Direct-to-consumer shipping mechanism can take different shapes as long as individuals can order and get at home.... Plan must pay shipping costs.... In-person mechanism must provide adequate number of locations.... Tests must be used and processed without involvement of a lab or other health care provider.... Temporary supply shortage will not destroy ability to rely on the safe Harbor ... Plan may disallow reimbursement for tests obtained from a private individual."  MORE >>

"In the case of leave requested due to a positive COVID test, the employer is permitted to require documentation of the positive test result and to withhold paid leave for employees who do not provide documentation.... The employer is required to provide written notice -- either in the employee's wage statement or separate writing provided on the pay date -- of the amount of paid supplemental leave used through the date of the notice."  MORE >>

"Previously, SB 95 authorized employers to draw down employees' SPSL balances when the employee was excluded from the workplace due to a COVID-19 case or work-related close contact exposure. Now, SB 114 expressly prohibits employers from requiring that employees use SPSL for this purpose ... This statutory change leaves employers in the potentially awkward and administratively difficult position of using other paid leaves accrued by the employee in order to provide for their continued compensation while they are excluded from the workplace."  MORE >>

"Narrowing the formulary for specialty drugs gives a plan's PBM a strong negotiating tool to secure better prices from preferred manufacturers whose products are believed clinically superior for a specific condition.... Structuring out-of-pocket costs to help encourage members towards the product with the lowest net costs, providing a strong cost containment strategy for specialty drugs."  MORE >>

"The Commission will vote on whether to issue Orders to large pharmacy benefits managers to study the competitive impact of contractual provisions, reimbursement adjustments, and other practices affecting drug prices, including those practices that may disadvantage independent or specialty pharmacies."  MORE >>

"The lawsuit claims Sutter used its market power for inpatient services in seven mostly rural Northern California areas where it is the only or dominant hospital to bind insurers in four other communities where it has competition. That allowed Sutter to overcharge for its own services, the lawsuit alleged, and caused nearly $400 million in insurance premium overcharges to the plaintiffs between 2011-2017."  MORE >>

"The fact sheet explains the investigation process and provides examples of enforcement actions closed during fiscal year 2021.... The agencies continue their steadfast commitment to mental health parity enforcement and have provided numerous resources to assist plans in their compliance efforts. Many of these resources are listed on the fact sheet's Appendix, including the biennially updated MHPAEA Self-Compliance Tool."  MORE >>

"[N]early three-quarters of employed individuals who are benefits eligible (70%) agree that they are more likely to work for an employer who offers employee-paid voluntary benefits -- including those like critical illness, hospital indemnity, disability income or accident insurance. However ... less than half of benefit-eligible employees (49%) actually took advantage of these voluntary benefit coverages offered by their employer."  MORE >>