"The Drug Enforcement Administration (DEA) will extend pandemic-era telehealth prescribing flexibilities for one year, through Dec. 31, 2025 ... The prescribing flexibilities put forward during the COVID-19 pandemic allowed licensed DEA providers to prescribe Schedule 2-5 controlled substances via telehealth."  MORE >>

"[T]he proposed requirement that group health plans maintain an exceptions process that defers to the individual's attending provider for all recommended preventive items and services, not just contraceptive coverage, may ultimately prove more significant for some plan sponsors. This article summarizes the background, key aspects of the proposed rules and implementation issues for employers."  MORE >>

"Effective November 21, 2024, employees with a primary place of employment in Massachusetts may use earned sick time to address their own physical and mental health needs, as well as those of their spouse, in the event of pregnancy loss or a failed assisted reproduction, adoption, or surrogacy.... The inclusion of leave for pregnancy loss and fertility treatment failures reflects an ongoing trend toward expanding leave protections[.]"  MORE >>

"The new law applies to all private employers in Missouri. However, certain employees are excluded from coverage ... Beginning May 1, 2025, eligible employees will accrue a minimum of one hour of paid sick leave for every 30 hours worked. Employers with at least 15 employees may limit employees to using 56 hours of paid sick time each year. All other employers may limit employees to using 40 hours of paid sick time annually."  MORE >>

"New York district court has preliminarily approved a class action settlement involving a health insurer's fertility policy that allegedly discriminated against LGBTQ individuals covered by the insurer's plans. The settlement would require the insurer to change its policy on eligibility for fertility treatment coverage and make payments to participants who incurred out-of-pocket expenses for fertility treatments due to the insurer's policy." [Goidel v. Aetna Life Ins. Co., No. 21-7619 (S.D.N.Y. Oct. 8, 2024)]  MORE >>

"The complaint ... alleges that the transaction would eliminate competition between UnitedHealth and Amedisys ... two of the largest home health and hospice providers in the United States. Eliminating the competition between UnitedHealth and Amedisys would harm patients who receive home health and hospice services, insurers who contract for home health services, and nurses who provide home health and hospice services." [U.S. v. UnitedHealth Group Inc. and Amedisys, Inc., No. 24-3267 (D. Md. complaint filed Nov. 12, 2024)]  MORE >>

"Designed to encourage wellness, tobacco surcharges are increasingly viewed as potentially punitive rather than supportive, prompting employers to reevaluate these programs’ structures."  MORE >>

"The cornerstone of any effective pharmacy benefits strategy lies in proactive utilization management.... You need to combine a robust navigation platform with independent care coordinators who serve as central connectors between employers, PBMs, prescribing providers and members. A platform with unique access to real-time data and insights makes it possible to intervene early for prior authorization reviews to proactively anticipate specialty drug requests and potentially change the trajectory of care before a claim is filed."  MORE >>

56 pages. "Sixty percent of employees choose the HSA-qualifying health option when given the opportunity. Nearly two-thirds of employers have seen an increase in HDHP use over time.... The average participant contribution in 2023 was $2,609, up from $2,323 the year before.... Three-quarters of employers make contributions to the HSA and most (57.2 percent) provide a set amount per coverage level.... Less than thirty percent of respondents indicated that they position the HSA as part of a retirement savings strategy to employees."  MORE >>

"While medications like GLP-1s play an increasingly important role in diabetes management, lifestyle and behavioral modifications cannot be overlooked for sustainable diabetes management.... Diabetes places significant pressure on healthcare costs for employers. U.S. companies incur $413 billion annually in diabetes-related costs alone."  MORE >>

"[T]raditional Medicare causes the elderly and people with disabilities to overpay for the drugs they use. This occurs for three reasons: [1] traditional Medicare requires three separate insurance plans for comprehensive coverage, [2] traditional Medicare drug plans are required to community rate, without adequate risk adjustment, and [3] [PBMs] are able to calculate patients' coinsurance based on list prices, rather than on the actual discounted prices the PBM pays the manufacturers."  MORE >>

"Three states found United's algorithmic system to limit mental health coverage illegal; when they fought it, the insurer agreed to restrict it.... The company is policing mental health care with arbitrary thresholds and cost-driven targets, highlighting a key flaw in the U.S. regulatory structure.... The poorest and most vulnerable patients are now most at risk of losing mental health care coverage as United targets them for cost savings."  MORE >>

"[The authors] explain why [they] believe that providers' win rate in arbitration reflects their ability to demonstrate with data that their offer is the more reasonable one. [They] also provide a perspective on factors driving the use of the federal IDR process, sharing [their] experiences as radiology providers to illustrate how the current process is not fulfilling the intent of the law. [The] goal is to inform policy makers as they consider potential reform."  MORE >>

"Address older worker healthcare needs ... A greater interest in insurance coverage ... Encourage retirement saving with matching and education ... Consider legal assistance as a company benefit ... Flex-time and other benefits."  MORE >>