"For the first time, CMS will enforce the aggregation restriction ... [P]lan sponsors will not be able to rely on their PBM's aggregate submission of pharmacy data. Instead, they will have to submit plan-level Rx data.... Preparing now to implement the new requirements will ease some of your burden when the filing is due.... [No] good faith relief is available for this third reporting submission. In addition, no deadline extension is available, even though June 1, 2024, falls on a Saturday."  MORE >>

"[T]he Court first found that Reliance disregarded its directive on remand and limited its interpretation of Plaintiff's regular occupation  ... With regard to the consideration of the 'risk of future harm' which Reliance had been directed to consider ... [t]he Court noted that Reliance ... rejected outright that Plaintiff's occupational duties cause any stress, because stress was not literally listed among the material duties returned by its labor market survey specialist nor did the Dictionary of Occupation Titles list 'stress' as a duty." [Aisenberg v. Reliance Standard Life Ins. Co., No. 22-0125 (E.D. Va. Feb. 21, 2024)]  MORE >>

"The [Fifth Circuit] is reviewing a district judge's ruling that wiped away that requirement for certain preventive services -- a ruling that was paused while the appeal plays out.... Not only will they be weighing whether to uphold the ruling that partially invalidated the mandate, they will also be deciding whether additional coverage requirements targeted by the challengers should be struck down, including no-cost coverage for some vaccines as well as for certain preventive health services for women and children." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022; on appeal to 5th Cir. No. 23-10326)]  MORE >>

"[A]ll manufacturers participating in the first cycle of Medicare drug price negotiations have responded with counteroffers.... Negotiations will continue over the next several months. If HHS and a participating manufacturer agree on a maximum fair price by the end of the negotiation period, those new negotiated prices will be published by September 1, 2024, and take effect beginning in 2026."  MORE >>

"By declining to argue the RFRA claims before the Fifth Circuit, the government may have saved the question for another day and avoided setting a national legal precedent. However, even applying the obligatory strict scrutiny standard, mandatory PrEP coverage should withstand the plaintiffs' RFRA claims for several reasons." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022; on appeal to 5th Cir. No. 23-10326)]  MORE >>

54 pages. "AHIP has significant concerns that certain elements of the MA and Part D Advance Notice could diminish the value and affordability of the MA benefits that millions of seniors and people with disabilities count on ... As proposed, many of these changes included in the Advance Notice would lead to significant variability in the MA program across geographic markets ... In addition, plans are continuing the multi-year implementation of changes required under the Inflation Reduction Act (IRA), underscoring the impact of dynamic and uncertain market conditions facing beneficiaries and their coverage."  MORE >>