"[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 >>

"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 >>

"[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 >>

"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 >>

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 >>

"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 >>

"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 >>

"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 >>

"[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 >>

"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 >>

"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 >>

"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 >>