"[The authors are] seeing an increased focus on ACA compliance and expect to see a ramp up in employer penalty notification. A failure to consider whether your plan is affordable when passing through any premium increases could result in an unintended penalty for each employee who enrolls in exchange coverage and qualifies for financial assistance."  MORE >>

"Although MHPAEA has been in effect for more than a decade now, regulators enforcing the law have often struggled to narrow the many gaps in access between MHSUD and medical/surgical benefits. One major driver of this has been the inability of regulators to effectively oversee insurer compliance with respect to NQTLs, especially network composition-related NQTLs. This proposed rule makes the NQTL standard more prescriptive and incorporates outcomes data, and if finalized ... would represent a significant step forward in MHPAEA enforcement."  MORE >>

"Medicare Part D imposes disclosure requirements on employers with group health plans that provide prescription drug coverage to Medicare- eligible individuals. Plan sponsors must provide the annual Medicare Part D creditable coverage disclosure notices to individuals before Oct. 15, 2023. Model notices are available for employers to use."  MORE >>

"During August 2023, a real-life illustration was shown highlighting how ACA requirements are not to be trifled with and the penalties are real.... [T]he IRS assessed exactions against Optimal Wireless for not providing adequate coverage to some employees.... [T]he U.S. Court of Appeals ruled against Optimal Wireless, agreeing with an earlier U.S. District Court ruling, that the exactions were a form of a tax and exempt from lawsuits ... Optimal Wireless is on the hook for the over $1.1 million in penalties to the IRS." [Optimal Wireless LLC v. IRS, No. 22-5121 (D.C. Cir. Aug. 8, 2023)]  MORE >>

"In litigation involving an employer's alleged notice violations under [COBRA], a district court rejected almost all of the employees' claims for why the notices were deficient. In the one claim that survived dismissal, an employee who was terminated in June 2020 alleged that the employer's COBRA election notice failed to state an enrollment deadline that accurately reflected COVID-19-related time extensions." [Bryant v. Walgreen Co., No. 23-1294 (N.D. Ill. Aug. 29, 2023)]  MORE >>

"Blue Shield of California's recent decision to unbundle its pharmacy benefit program and work with multiple vendors ... wiped out $20 billion in market capitalization of the owners of the three largest pharmacy benefit managers within hours of the announcement.... This new model is a great opportunity [for employers] to request stronger guaranteed discounts, rebates, and even trend guarantees.... [E]mployers should request the right to audit these guarantees to ensure transparency and accountability."  MORE >>

"To understand the extent to which decreased returns may impact innovation, [the authors] analyzed how much it costs on average to bring a drug to market and how much these companies have earned from the selected drugs since their launch. Not only are revenues enough to justify the investment in these particular drugs, they are enough to fund several more generations of pharmaceutical development. Lower negotiated prices are unlikely to deter further investment in similar medications."  MORE >>

"[P]rivate companies that provide voluntary Medicare Part D prescription drug coverage received $48.6 billion in rebates from drug manufacturers in 2021. Three therapeutic drug classes accounted for 73 percent of rebates ... [R]ebates may ... lower Medicare drug spending ... However, rebates do not lower individual beneficiary payments for drugs ... GAO found payments by beneficiaries were more than plan sponsor payments, after accounting for rebates, for 79 of the 100 drugs receiving the most rebates." [GAO-23-105270]  MORE >>

"The [IRS] today announced tax relief for individuals and businesses affected by Idalia, anywhere in South Carolina. These taxpayers now have until Feb. 15, 2024, to file various federal individual and business tax returns and make tax payments.... All 46 counties in South Carolina qualify. Individuals and households that reside or have a business in these counties qualify for tax relief."  MORE >>