"The law directly regulates PBMs and pharmaceutical manufacturers operating in Florida both in terms of overall licensing and certification requirements to conduct business in the state, and in terms of limitations on the contracts a PBM can enter into. The contract rules apply both to PBM contracts with applicable pharmacies and PBM contracts with health plans, such as those offered via employer group health plans."  MORE >>

"[T]his New York state law applies surcharges on hospital bills that are ultimately passed through and absorbed by group health plan sponsors.... [B]oth insured and self-funded plans operating in New York will encounter surcharge duties as implicated by this law."  MORE >>

"[T]he Vermont Family and Medical Leave Insurance Plan [is] a program employers can buy into to cover partial wages for employees who need to be out of work due to a serious health condition or to care for a family member who is sick. The plan became available to all state employees in 2023, and beginning July 1, 2024, will be available to Vermont employers with 10 or more employees."  MORE >>

"The Supreme Court's decision allows two rulings favorable to the plaintiff to stand. This decision ... reinforces existing law and case law that require health plans to take the input of patient's clinicians seriously. It also puts a finer point on the importance of health plans meaningfully engaging with clinicians and members when assessing claims." [D.K. v. United Behavioral Health, No. 21-4088 (10th Cir. May 15, 2023; cert. denied Feb. 20, 2024, No. 23-586)]  MORE >>

"[T]he plan administrator of an employer-sponsored, group health plan, particularly one funded by a VEBA, has a fiduciary responsibility to engage in a prudent process when selecting and negotiating with its PBM, which may require an open RFP.... [P]lan fiduciaries should have ongoing processes for monitoring and reviewing plan fees, the prescription drug formulary, and the PBM's performance." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

"In light of the J&J case and recent uptick in group health plan litigation alleging breach of fiduciary duty, group health plan fiduciaries may wish to evaluate their current fiduciary governance structure to ensure a process is in place for selecting and monitoring group health plan service providers. This may include a renewed focus on contract terms and monitoring group health plan costs, especially prescription drug costs and the amounts paid to PBMs and the plans' consultants and administrators, in order to ensure such costs remain reasonable."  MORE >>

"From January to June 2023, over 288,000 disputes were submitted through the federal independent dispute resolution [IDR] portal. The IDR has struggled to keep up with the substantial number of submissions since the portal was opened in 2022. According to CMS, the majority of these disputes were initiated by a small number of providers, who have been vocal in their belief of insurers taking advantage of the law."  MORE >>

"U.S. healthcare technology giant Change Healthcare has confirmed a cyberattack on its systems.... The incident began early on Wednesday morning on the U.S. East Coast ... The specific nature of the cybersecurity incident was not disclosed.... [A Michigan local newspaper] is reporting that local pharmacies are experiencing outages due to the Change Healthcare cyberattack."  MORE >>

"[This article discusses] ERISA's prohibited transaction rules, the permissible and impermissible uses of plan assets, and other compliance issues that may arise in connection with the management of plan assets."  MORE >>

"ERISA will reach a major milestone in 2024 -- its fiftieth anniversary since its enactment on Labor Day of 1974. However, there is much about how the law works that remains unsettled.... 2023 produced new ERISA regulatory initiatives and groundbreaking judicial rulings.... [S]ome of the major highlights are discussed [in this article], along with a prediction about what 2024 may bring."  MORE >>