"The most recent Report to Congress, which is over 100 pages, is instructive and provides several important lessons: [1] MH/SUD parity remains an enforcement priority.... [2] Non-compliant plans reported to Congress.... [3] Opportunity to think carefully and deeply.... [4] Comparative analysis requirement is no longer new.... [5] Top areas of DOL focus ... [6] More exclusions than expected, but also some successes."  MORE >>

"Employers who use the FLP safe harbor will need an employee-only premium rate of $101.93 or less for plans beginning in 2024 for the lower 48 states and Washington, D.C. Employers using the Rate of Pay or W-2 safe harbors will need to evaluate their premiums considering the 8.39% threshold.... To maintain affordability, an employer may have to lower health plan rates in 2024."  MORE >>

"Following the Tenth Circuit's decision, the case has been remanded to the district court that originally heard the case. Pending the outcome of the district court proceedings, Oklahoma is likely to request that the Tenth Circuit rehear the case, and/or pursue an appeal to the Supreme Court.... [T]he Mulready decision ... is a conservative, well-reasoned application of prior precedent. Had the Tenth Circuit reached an opposite conclusion, it would have been a sea change in the world of both ERISA preemption and state regulation of ERISA plans." [PCMA v. Mulready, No. 19-0977 (10th Cir. Aug. 15, 2023)]  MORE >>

"The percentage of private-sector establishments offering a self-insured health plan increased through 2016 but has since ebbed and flowed with no discernible long-term trend.... Since 2018, the percentages of small and medium-sized establishments offering at least one self-insured plan both increased.... Self-insurance varied substantially by state."  MORE >>

"For all its advantages, ... self-funding is not without its challenges -- some of which may not become apparent in the first year of coverage.... [R]egardless of whether a company is self-funded or fully insured, the claim exposure, volatility and administrative needs associated with managing multiple moving parts can be unanticipated and unbudgeted.... One promising alternative is the individual coverage health reimbursement arrangement (ICHRA), a potential game-changer in the health care landscape."  MORE >>

"While generic drugs now account for more than 90 percent of all retail prescriptions filled in the United States, they account for only 20 percent of total spending on prescription drugs.... [On] average, retail prices for widely used generic prescription drugs declined between 2006 and 2020. The findings also highlight the unique pricing dynamics in the generic drug market when compared with those in the brand name drug market."  MORE >>

"[E]ight separate bills to change PBM practices have recently been introduced or advanced out of committee ... The current proposals will introduce some transparency on PBM and pharmaceutical pricing ... Rebate retention and spread pricing bans will decrease profit margin for some PBMs, but that is very unlikely to be significant.... A federal ban on accumulators ... will not affect the closely related maximizer programs ... None of this will substantially affect the business of reducing pharmaceutical costs for employers, insurers, and state and federal governments. Ultimately the best approach to reducing costs for medications is for the government to set prices, just as most other higher-income countries do."  MORE >>