"In [Technical Release 23-01], the DOL identified four specific types of data that they may require plans and issuers to collect and evaluate as part of their comparative analyses for NQTLs related to network composition.... [T]he DOL seems to be strongly trending toward requiring plans to collect and have available significant amounts of data relating to network adequacy. Plans should commence discussions with their TPAs on data availability and/or consider implementing contractual language that would provide access rights to such data."  MORE >>

"If a recent federal judicial ruling stands, employers could start imposing cost sharing for select preventive services and medications. Enrollees utilizing these services could face a substantial increase in their personal out-of-pocket spending, while employer savings from reintroducing cost sharing would be negligible."  MORE >>

"IRS Notice 2019-45 allows health savings account (HSA)-eligible health plans the flexibility to cover 14 medications and other health services used to prevent the exacerbation of chronic conditions prior to meeting the plan deductible.... [B]etween 2018 and 2021, the IRS notice increased the use of 3 of the 7 medical services by more in HSA-eligible plans compared with non-HSA-eligible plans.... Use of health services may not have changed for all targeted services and prescription drugs because many employers substituted copayments and/or coinsurance for deductibles."  MORE >>

"[T]he DOL found [Prudential] collected life insurance premiums for extended periods of time but then denied claims citing the failure to provide the required [evidence of insurability (EOI)].... The settlement with Prudential notes that group policyholders, such as employers, who collect premiums without confirming that the insurer has approved the EOI may be liable for beneficiaries' death benefit claims."  MORE >>

"What does the arbitrary and capricious standard of review mean in relation to ERISA cases? ... When is the arbitrary and capricious standard applicable? ... How to defeat an arbitrary and capricious claim denial?"  MORE >>

"Prices for semaglutide and tirzepatide drugs are higher in the U.S. than in other countries and the U.S. has by far the highest rates of adults with obesity.... The list price for one month of Ozempic in the U.S. ($936) is over 5 times that in Japan ($169), and about ten times more than in Sweden, the United Kingdom, Australia, and France.... A month's supply of Wegovy at the maintenance dosage is priced at $1,349 in the U.S., compared to $328 in Germany and $296 in the Netherlands."  MORE >>

" 'If the applicability of ERISA preemption to plan design choices relating to prescription drug benefits were to be undermined, it would significantly and negatively remake the regulatory landscape for ERISA plans -- to the detriment of employers, employees, and their families,' said the Council's Ilyse Schuman[.]" [PCMA v. Mulready, No. 19-0977 (10th Cir. Aug. 15, 2023)]  MORE >>