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Health & Welfare Plans Newsletter

July 9, 2024

4 New Job Opportunities 4 New Job Opportunities


[Guidance Overview]

2025 Maximum Out-of-Pocket Limits, HSA Parameters, and Excepted Benefit HRA Limits

"[A chart] compares this year's limits and parameters to the 2025 limits. For the first time, the maximum out-of-pocket limits for non-grandfathered health plans will decrease."  MORE >>



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Applying Loper Bright, Three District Courts Bar Enforcement of ACA Section 1557 Final Regulations on Gender Identity

"In rulings that apply the recent Supreme Court decision overruling Chevron deference, three district courts have issued stays and preliminary injunctions barring [HHS] from enforcing provisions of [the ACA Section 1557] nondiscrimination rule as applicable to gender transition services. While one of the court's stays is nationwide, the others are more limited." [Texas v. Becerra, No. 24-0211 (E.D. Tex. July 3, 2024); Tennessee v. Becerra, No. 24-0161 (S.D. Miss. July 3, 2024); Florida v. HHS, No. 24-1080 (M.D. Fla. July 3, 2024)]  MORE >>

Thomson Reuters Practical Law

SCOTUS Will Decide Whether ADA Allows Former Employees to Sue Over Post-Employment Benefits

"[SCOTUS is] now poised to resolve the circuit split over whether a former employee loses her right to sue over post-employment benefits that she accrued during her employment. A ruling in favor of Stanley may affect how employers administer post-employment policies and benefits. Changes to post-employment benefits plans that disproportionately affect disabled former employees may be susceptible to challenge." [Stanley v. City of Sanford, Florida, No. 22-10002 (11th Cir. Oct. 11, 2023; cert. pet granted No. 23-997, Jun. 24, 2024)]  MORE >>

Hunton Andrews Kurth LLP

Do HDHPs Really Save Employers Money?

"Plan members who select the HDHP option are, on average, higher paid, well educated, and less expensive from a claim perspective. Conversely, more expensive plan members are often of lower socio-economic status and usually select the lower-risk PPO plan option.... [The] data (see below) has consistently shown little to no correlation between per employee per year plan costs and the percentage of HDHP enrollment."  MORE >>

Chelko Center for Benefits Management

Exceptional Usefulness and Quality icon Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies (PDF)

73 pages. "The market for pharmacy benefit management services has become highly concentrated, and the largest PBMs are now also vertically integrated with the nation's largest health insurers and specialty and retail pharmacies.... [T]he leading PBMs can now exercise significant power over Americans' access to drugs and the prices they pay.... Vertically integrated PBMs may have the ability and incentive to prefer their own affiliated businesses ... [I]ncreased concentration may give the leading PBMs the leverage to enter into complex and opaque contractual relationships that may disadvantage smaller, unaffiliated pharmacies and the patients they serve.... PBMs and brand drug manufacturers sometimes negotiate prescription drug rebates that are expressly conditioned on limiting access to potentially lower cost generic alternatives."  MORE >>

Federal Trade Commission [FTC]

Drug Middlemen PBMs Are Hiking the Price of Cancer Drugs, FTC Says

"The FTC said in its interim report that 'increasing vertical integration and concentration has enabled the six largest PBMs to manage nearly 95 percent of all prescriptions filled in the United States.' Those six are Caremark Rx, LLC; Express Scripts, Inc.; OptumRx, Inc.; Humana Pharmacy Solutions, Inc.; Prime Therapeutics LLC; and MedImpact Healthcare Systems, Inc.... FTC Chair Lina M. Khan said the findings show that the middlemen are 'overcharging patients for cancer drugs,' bringing them additional revenue of more than $1 billion."  MORE >>


Pharmacies and Reference Based Pricing

"In an effort to curtail the significant increases in prescription drug costs, some employers have started to apply the reference-based pricing model to their prescription drug plans. By encouraging employees to be active participants in their healthcare journey, it can enable them to take control of some of the costs that come along with it."  MORE >>


The Potential Role of the Nonprofit Pharmaceutical Industry in Addressing Shortages and Increasing Access to Essential Medicines and Low-Cost Medicines (PDF)

"Findings suggest that while nonprofit pharmaceutical companies hold promise in addressing drug shortages and enhancing access, their capacity and sustainability may be limited due to low production volumes, uncertainties about funding, and inexperience navigating complex tax, regulatory, and reimbursement systems."  MORE >>

Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS]


AI and Health Insurance Prior Authorization: Regulators Need to Step Up Oversight

"[The authors] focus on the use of AI in [prior authorization] in particular, [defined] as the process an insurance plan uses to make a pre-treatment coverage decision according to clinical criteria used to determine if the service is medically necessary. [They] also note suggestions policy makers should consider for addressing these challenges."  MORE >>

Health Affairs Forefront

Benefits in General

Cybersecurity Policymaking Post-Chevron

"The ruling will likely result in increased judicial scrutiny over regulatory decisions, directly affecting cybersecurity rules and enforcement actions by agencies ... Business compliance will likely need to evolve to account for uneven application of cybersecurity laws across jurisdictions.... Compliance efforts may need to adapt to more frequent modification of security regulations as lawsuits work through the court system." [Loper Bright Enterprises, Inc. v. Raimondo, Sec. of Comm., No. 22-451 (S. Ct. Jun. 28, 2024)]  MORE >>

Venable LLP

District Court Enjoins, and Signals Readiness to Invalidate, the FTC's Non-Compete Ban

"In order to rule in favor of the plaintiffs opposing the final rule, the Court had to make four critical findings ... In finding for plaintiffs on all four of these elements, the Court demonstrated, in no uncertain terms, that it intends to find the FTC's rule unenforceable as a whole and against any party (not just the parties to the lawsuit) when it reaches its final decision on or before August 30." [Ryan LLC v. Federal Trade Commission (no. 24-0986 (N.D. Tex. Jul. 3, 2024)]  MORE >>


Court Grants Preliminary Injunction Against FTC Ban on Non-Compete Agreements

"This preliminary decision indicates that the court is likely to issue a permanent injunction when it decides the case on the merits in August. Plaintiffs will likely ask for the decision to have nation-wide effect. Given the Supreme Court's recent decision ... overturning Chevron's deference to administrative agencies, this could be the end of the FTC Rule." [Ryan LLC v. Federal Trade Commission (no. 24-0986 (N.D. Tex. Jul. 3, 2024)]  MORE >>

Trucker Huss

Employee Benefits Jobs

View job as Client Service Manager for July Business Services

Client Service Manager

July Business Services


View job as Client Service Manager for July Business Services

View job as Retirement Implementation Coordinator for Alerus

Retirement Implementation Coordinator


Hopkins MN / Grand Forks ND / Fargo ND / Phoenix AZ / East Lansing MI / Hybrid

View job as Retirement Implementation Coordinator for Alerus

View job as Retirement Account Administrator, Senior for Alerus

Retirement Account Administrator, Senior


Remote / MN / ND

View job as Retirement Account Administrator, Senior for Alerus

View job as Senior Cash Balance and 401(k) Retirement Account Administrator for Alerus

Senior Cash Balance and 401(k) Retirement Account Administrator



View job as Senior Cash Balance and 401(k) Retirement Account Administrator for Alerus

Press Releases

Pooled Plan Provider NPPG Announces SEC Registration


ShareBuilder 401k Launches New Solo 401(k) Plan for the Self-Employed

Sharebuilder 401k

Webcasts and Conferences
(Health & Welfare Plans)

What Does The Future Hold For Non-Competes After The FTC's Proposed Ban?


White and Williams LLP

HSA Fundamentals

August 20, 2024 WEBINAR


Last Issue's Most Popular Items

Employer Considerations for Health Plan Coverage of GLP-1 Drugs

Willis Towers Watson

SCOTUS and Group Health Plans: Notable Decisions from the 2024 Term, and Upcoming Cases to Watch

Winston & Strawn LLP

DOL Regulatory Agenda, Spring 2024: Includes New Reg Project

U.S. Department of Labor [DOL]

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BenefitsLink® Health & Welfare Plans Newsletter, ISSN no. 1536-9595.

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