"The purpose of this document is to provide interested parties with draft part one guidance on a select set of topics for the Maximum Monthly Cap on Cost-Sharing Payments Program, which ... requires all Medicare prescription drug plans to offer their Part D enrollees the option to pay their out-of-pocket (OOP) Part D drug costs through monthly payments over the course of the plan year instead of as upfront payments at the pharmacy point of sale beginning January 1, 2025.... This guidance document will be followed by a second round of guidance, set to be released by early 2024." [Also available: Fact Sheet and Implementation Timeline]  MORE >>

"The Tenth Circuit parted ways with the district court with respect to the appropriate remedy. The district court granted benefits and attorneys' fees to the plaintiffs, but the Tenth Circuit held that the appropriate remedy was to remand the claims back to [United Behavioral Health (UBH)] for further and proper consideration. The court also vacated the award of attorneys' fees, which it explained should be reconsidered after UBH properly decided the claims." [P. v. United Healthcare Ins. Co., No. 21-4129 (10th Cir. Aug. 15, 2023)]  MORE >>

"Law 41-2022 sought to repeal some of the reductions in benefits enacted by the 2017 Labor Reform for employees hired on or after January 26, 2017, including the reduction in the vacation accumulation rates, the increase in the number of hours worked to qualify for the Christmas bonus, the cap on the statutory severance, the extension of the automatic probationary period, and the shortening of the statute of limitations to file employment-related claims." [In re: The Financial Oversight and Management Board for Puerto Rico, Nos. 23-1267, 23-1268, 23-1358 (1st Cir. Aug. 10, 2023)]  MORE >>

"Last year, 44% of employers saw a rise in mental health concerns, while 77% of employers reported an increase this year ... One in two employers said cancer was the No. 1 driver of health care costs, and 86% said it ranked among the top three, likely due to late-stage cancer diagnoses from the pandemic.... While 92% of employers are concerned about high-cost drugs in the pipeline, 91% reported concern about pharmacy cost trend overall."  MORE >>

"The projection increase, which assumes employers do not implement employee cost sharing increases and other cost saving strategies, is nearly double the 4.5 percent increase to health care budgets that employers experienced from 2022 to 2023. On average, the budgeted health care plan cost for clients is $13,906 per employee in 2023."  MORE >>

"Individual rate hike requests range from 9.8% to 17.5%, while proposed small group rate request range from 7.5% to 23%.... Insurers attributed the rate hike request to higher health care costs from utilization rates and other factors."  MORE >>

"The audit recommended the state enact legislation that focuses on patient and pharmacy protections and increasing transparency in the prescription drug supply chain."  MORE >>

"Despite its stated purpose, the ensuing lawsuits, the departments' ever-changing rules and implementation of said rules by the IDREs have left providers and their counsel scratching their heads in efforts to get consistently reimbursed for out-of-network emergency services. In this article, [the authors] discuss issues that have arisen with the IDR process and provide practical solutions to hopefully ensure success in reimbursements."  MORE >>