"[A chart shows] the list of negotiated prices, which the statute refers to as Maximum Fair Prices (MFPs), for 10 drugs covered under Medicare Part D that will go into effect beginning January 1, 2026, based on negotiations and agreements reached between CMS and participating drug companies.... When the negotiated prices go into effect in 2026, people enrolled in Medicare prescription drug coverage would save under the projected defined standard benefit design an estimated $1.5 billion." [Also available: Fact Sheet and Infographic]  MORE >>

"The latest amounts are based on a cost-of-living increase of 1.03241%. These adjustments are effective for penalties assessed on or after August 8, 2024, for violations occurring on or after November 2, 2015.... The annual adjustments to penalties are designed to preserve their deterrent effect in the face of inflation. HHS's 'annual' adjustments are supposed to made by January 15 of each year, but in practice have come at irregular intervals."  MORE >>

"CMS will select up to 15 more drugs covered under Part D for negotiation for 2027 by February 1, 2025. CMS will select up to 15 more drugs covered by Part B or Part D for 2028, and up to 20 more Part B or Part D drugs for each year after that, as required by the Inflation Reduction Act."  MORE >>

"Under Part D, [employer group waiver plan (EGWP)] sponsors receive funding from various sources to offset the cost of the group plan.... Changes in 2025 ... could reduce the total level of these third party payments to an EGWP sponsor, thus increasing their net plan cost. This presents plan sponsors with some unpleasant choices: [1] Absorb the cost increase, making retirees happy, but their finance department unhappy. [2] Pass the cost increase onto retirees in the form of contribution increases or benefit cuts, leading to a happy finance department, but less-than-happy retirees."  MORE >>

"Among the 167 million people with employer-sponsored insurance in 2022, 3.4 million people used at least one of the ten drugs that have been identified for Medicare price negotiations.... The most common was Jardiance, a drug used to treat diabetes and heart failure, with over 911,000 enrollees; the least common was Imbruvica, a drug used to treat blood cancers, with only 5,000 enrollees."  MORE >>

16 pages. "GLP-1 drugs like Ozempic and Wegovy have gained popularity as effective weight loss treatments, and employers are increasingly facing pressure include these medications in their health plan coverage.... Biosimilars ... offer the potential for both significant cost savings and increased patient access as patents expire for the blockbuster biologics they mimic.... Specialty pharmacy plays a crucial role in managing complex and chronic conditions[.]"  MORE >>

"The average cost of employer-sponsored health care coverage in the U.S. is expected to increase 9.0 percent, surpassing $16,000 per employee in 2025 ... This projected increase, which assumes employers do not implement employee cost sharing increases and other cost saving strategies, is higher than the 6.4 percent increase to health care budgets that employers experienced from 2023 to 2024 after cost savings strategies. On average, the budgeted health-plan cost for clients is $14,823 per employee in 2024"  MORE >>

"ESI reimbursement for vascular procedures were 3.1 times higher than the Medicare FFS payment rates. At the same time, ESI reimbursement for skin procedures were 1.4 times higher than Medicare FFS payment rates. The vast majority of (76%) of ASC procedures studied have ESI payments that are greater than the corresponding median Medicare reimbursed amounts."  MORE >>

"Employers should be clear in communication materials that COBRA will not be an option once the organization no longer has active covered employees and the plan terminates. The company should also take into account other items such as the FSA, the welfare benefits such as life and disability, and the need to file a final Form 5500 post-termination."  MORE >>

"A slew of lawsuits against retirement plan fiduciaries caused a restructuring of the decision-making process for retirement plans, but the same committee structure, documentation, training, and decision-making process has not always been implemented for welfare plans despite the same fiduciary obligations under the law — and plaintiffs’ lawyers are catching on."  MORE >>

"[1] Mental Health Parity ... The employer and insurance carrier communities ... have been bracing for the release of the final regulations, which the Unified Agenda indicates will be some time in August 2024.... [2] Advanced Explanation of Benefits (AEOBs) ... [We] should expect proposed regulations in March 2025.... [3] [T]he Federal Departments are working on HIPAA regulations that are intended to improve cybersecurity measures for medical providers, health plans and third parties that handle and store personal health information. The Unified Agenda stipulates that proposed regulations will be released in December 2024."  MORE >>

"[1] Tell a compelling benefits story ... [2] Bring benefits to life with realistic scenarios ... [3] Pull in employee testimonials ... [4] Make messages relevant ... [5] Dust off your delivery method."  MORE >>