"To comply with the Consolidated Appropriations Act of 2021, employers must attest that service providers have removed gag clauses from health care contracts by December 31, 2024 ... Plans and carriers must complete the Gag Clause Prohibition Compliance Attestation form electronically, using the form provided [by HHS]."  MORE >>

"Which employees are entitled to Paid Leave under Proposition A? ... How can employees use Paid Leave under Proposition A? ... What happens to employees' unused Paid Leave at the end of the year or the end employment? ... Can employers require employees to provide advance notice of their need for Paid Leave? ... Can employers require employees to provide proof of their need for Paid Leave?"  MORE >>

"Owens & Minor alleges that its review of the Plan's claims data reveals that Anthem, an alleged functional fiduciary of the Plan ... violated its duties to the Plan in myriad ways, including by [1] causing the Plan to overpay claims or pay claims multiple times; [2] pocketing rebates and provider discounts that should have benefitted the Plan; and [3] agreeing to less favorable terms with providers for self-insured plans in order to benefit its fully insured business.... The complaint supplements the ERISA claims with state law causes of action for breach of contract, breach of fiduciary duty and the duty of good faith, and fraud." [Owens & Minor, Inc. v. Anthem Health Plans of Virginia, Inc., No. 24-0820 (E.D. Va. complaint filed Nov. 18, 2024)]  MORE >>

"Currently, fewer than one in five large employers are covering such prescriptions despite the boom in popularity of expensive GLP-1 drugs to treat weight loss ... [Employers] who follow the Biden administration's move to expand access to anti-obesity medications such as Ozempic and Wegovy ... should be prepared to pay bigger health insurance premiums for their workers."  MORE >>

"[The proposal] would authorize Medicare and Medicaid coverage of anti-obesity medications for people with obesity but not people who are overweight.... Medicare Part D drug plans and state Medicaid programs could still apply utilization management tools such as prior authorization, which could limit access.... [T]he proposal would increase Medicare spending by $25 billion ... over 10 years (net of rebates) and would apply to around 3.4 million people with Medicare[.]"  MORE >>

"The Biden administration's move, which would take effect in 2026, would expand access to drugs like Novo Nordisk's Ozempic or Wegovy for 3.4 million Americans on Medicare ... Officials said they do not expect this would raise seniors' premiums.... It's unclear how the Trump administration will view Medicare coverage of GLP-1s.... The cost is expected to be a key sticking point, particularly as the administration promises to cut back federal spending[.]"  MORE >>

"Value-based care emphasizes improved patient outcomes while managing costs, something easier said than done. The transition requires CFOs to rethink their financial strategies to not only ensure the health system's sustainability, but also to strengthen its role as a vital community partner."  MORE >>

"A growing majority of consumers (75%,+12% since April 2023) are satisfied with their current employer-provided coverage.... 74% (+6%) prefer to get their coverage through their employer over a federal or state government program.... While unhappy with coverage costs, 63% of respondents identified the comprehensiveness of coverage as a greater priority than affordability (31%).... 67% of respondents reported considering it important for health insurance plans to cover telehealth services"  MORE >>

"GAO compared monthly premiums per covered individual for employer-sponsored and Marketplace plans ... [and] found that ... in 2022, the estimated average monthly premiums for employer-sponsored plans were lower than the average premiums for Marketplace plans.... [A]fter employer contributions to employee premiums and federal premium tax credits for Marketplace plans, the average estimated monthly enrollee contributions to premiums per covered individual for employer-sponsored plans were higher than the average enrollee contributions to premiums for Marketplace plans. Taxes complicate comparability because enrollee contributions to employer-sponsored plans do not reflect their cost after tax savings." [GAO-25-106798 Nov 27, 2024]  MORE >>

"Even though surveys suggest one-in-eight Americans have tried GLP-1s (15 million), many patients have been largely left to figure out how to take the medication and maintain the weight loss on their own. For many, behavioral health screening and support is largely absent from GLP-1 prescriptions provided by primary care or online virtual care solutions. In my view, it's irresponsible given the need. What should employers, their advisers and healthcare professionals be doing about this?"  MORE >>

"[R]egulators have been busy issuing much-needed guidance ... relating to [1] implementing penalty-free withdrawals for emergency personal expenses and domestic abuse distributions, [2] the RMD rules, and [3] implementing the long-term, part-time employee (LTPT) rules, among others.... Health and welfare plans have seen a significant uptick in the amount of new guidance compared with a typical year.... [A] number of lawsuits filed against retirement plan sponsors alleging violations of fiduciary duties with respect to the use of retirement plan forfeitures.... As with retirement plans, health and welfare plans are subject to fiduciary duties under ERISA."  MORE >>