Aug. 6, 2024. "Form 1095-B is used to report certain information to the IRS and to taxpayers about individuals who are covered by minimum essential coverage. Eligibility for certain types of minimum essential coverage can affect a taxpayer's eligibility for the premium tax credit."  MORE >>

"Action Items by December 23, 2024: [1] Revise the health plan's HIPAA privacy policies and procedures ... [2] Be prepared to require requestors' attestations when reproductive health care-related PHI is requested for a non-prohibited purpose. [3] Train applicable workforce members ... [4] Update business associate agreements ... [5] Review forms and templates used in communications or otherwise ... Action Item by February 16, 2026: Update Notice of Privacy Practices to include the newly enacted protections."  MORE >>

"[The authors] combined claims data on branded retail prescription drugs with estimates on rebates to provide new price index measures based on pharmacy prices, negotiated prices (after rebates), and out-of-pocket prices for the commercially insured population during the period 2007-20.... [A]lthough retail pharmacy prices increased 9.1 percent annually, negotiated prices grew by a mere 4.3 percent, highlighting the importance of rebates in price measurement.... [C]onsumer out-of-pocket prices diverged from negotiated prices after 2016, growing 5.8 percent annually, while negotiated prices remained flat."  MORE >>

"The PBM business model has evolved from an offering focused on claims adjudication to include dispensing network development, health insurance coverage, formulary development, manufacturer rebate negotiation, and other services. Today, the three largest PBMs now manage nearly 80% of all prescriptions filled in the United States. This market concentration, coupled with reforms that may result from transparency initiatives, has implications for nearly all healthcare value chain stakeholders."  MORE >>

"Key waivers will conclude at the close of 2024 unless legislation is passed to extend them.... Among the flexibilities scheduled to expire is nationwide Medicare payment eligibility for services furnished to beneficiaries in their homes. Established law allows for reimbursement only for telehealth provided to patients living in specifically designated rural areas, and only while those patients are visiting a medical facility."  MORE >>

"The undersigned organizations, which represent a wide array of constituencies -- including labor, environmental advocates, employers, health and welfare plans, and benefits administrators -- continue to strongly support rulemaking to establish an e-delivery safe harbor for health and welfare plan disclosures ... We also recognize the potential interaction with forthcoming rulemaking on Advanced Explanation of Benefits (AEOBs). In this letter, we address this potential interaction and provide key reasons why rulemaking should be prioritized this year."  MORE >>

"NCPA asks CMS to provide regulations outlining Part D pharmacy contracting guardrails to ensure fair and common-sense contracting between Part D plans/PBMs and pharmacies. This is essential to eliminate abuses in contracting practices and processes from Part D plans and PBMs, and to ensure patient access to accurate information ... We believe that plans/PBMs are attempting to lock our members into multiple year contracts to game CMS' pharmacy access standards in Medicare Part D."  MORE >>

"Despite the relatively sanguine 2024 report, ... it's important to remember that the Medicare program operates in an extremely costly health system.... [The] program's costs are high and are projected to grow as a percentage of GDP.... [An] aging population explains much less than half of the projected future growth in Medicare. The rest comes from the costs for hospital and physician services rising faster than GDP."  MORE >>

21 pages. "With a separate tax code and constitution, Puerto Rico has its own tax, benefit and insurance laws. Nonetheless, many (but not all) U.S. laws apply to this territory ... [This article] summarizes major requirements and special issues facing Puerto Rico-based employers and U.S. employers with Puerto Rico-based employees, including an overview of complicated tax-related health and fringe benefit rules, leave laws, the [ACA] and more."  MORE >>