"[1] Comparative analysis must measure NQTL effects as written and in operation ... [2] New required comparative analysis content ... [3] New plan fiduciary certification ... [4] Short timeline for providing comparative analyses ... [5] New definitions effective in 2025".  MORE >>

"Although prior regulatory relief permitted employers to provide telehealth coverage without cost sharing, that relief is due to expire at year-end. Absent an extension ... individuals who are covered by an HDHP with no cost sharing for telehealth services will not be eligible to contribute to a health savings account (HSA) in 2025."  MORE >>

"Voters in Alaska, Missouri and Nebraska approved referendums in November 2024 to establish respective statewide paid sick leave requirements, joining 18 other states (and the District of Columbia) that have existing paid sick leave mandates.... [T]he new mandates allow employees to use paid sick leave to care for ill family members, among other uses, which may pose new requirements on some employers' existing voluntary paid sick leave programs."  MORE >>

"[P]laintiffs have filed nearly 30 suits against plan sponsors alleging that their health plans violate ERISA Section 702, which prohibits discrimination based on health status.... Plaintiffs have argued that prospective avoidance of a surcharge, alone, is inadequate. They say the DOL's regulation requires retroactive reimbursement of surcharges -- e.g., if a participant quits smoking or satisfies the alternative standard in November, plaintiffs assert not only should the December surcharge be lifted, but the participant should also receive reimbursement for the surcharges paid since January."  MORE >>

28 pages. "ASPE developed this report to provide background on the prescription drug market, discuss the need for [the Prescription Drug Data Collection (RxDC)], and summarize the findings from the initial two years of RxDC. This report contains the following sections: [1] Background: Prescription drug coverage, benefit design, and the pricing of retail prescription drugs ... [2] The need for RxDC ... [3] Brief description of the 2020 and 2021 RxDC and initial findings ... [4] Conclusion: reviews the results, presents suggestions for improving the data, and discusses opportunities for further analyses."  MORE >>

142 pages. "To help inform ASPE's report, a RAND team Section examined U.S. trends in prescription drug coverage, prices, and spending Section summarized extant evidence on associations between drug spending and premiums Section to the extent feasible, conducted illustrative analyses using 2020 and 2021 [Prescription Drug Data Collection (RxDC)] data. In this report, the authors share their findings from their analysis and recommendations to the government to address limitations of the RxDC data."  MORE >>

"Enforcement of ransomware security incidents has dominated the breach enforcement actions and resolution agreements issued in 2024, with failure to conduct a compliant risk analysis as the overarching theme."  MORE >>

"[CMS] recently adopted a batch of prior authorization rules for 2024 and later years. One, for example, discourages the plans from conducting repeated reviews for patients who are continuing to get care for the same condition.... The AMA wants the [DOL] to build on the CMS requirements and take them a step further, by imposing a 24-hour response time limit on employer plans for urgent prior authorization requests and a 48-hour limit for non-urgent requests."  MORE >>

"Brian Thompson, a longtime UnitedHealth Group Inc. executive, was fatally shot in midtown Manhattan early Wednesday morning ... A 20-year veteran of UnitedHealth, Thompson was one of the company's most senior executives.... The insurance unit he oversaw is expected to bring in $280 billion in revenue this year, and is the country's largest health insurer."  MORE >>

"Bundling self-funded plans with a carrier as your TPA, network, and PBM? A recipe for disaster. If you're large enough to self-fund, don't bundle. Period. Why do so many consultants recommend it anyway? The answer is a cocktail of laziness, greed, and institutional capture." [Owens & Minor, Inc. v. Anthem Health Plans of Virginia, Inc., No. 24-0820 (E.D. Va. complaint filed Nov. 18, 2024)]  MORE >>

"[T]he ACA is expected to remain intact under Trump. However, there could be substantial changes based on his vow to improve affordability, which will have compliance ramifications. ... [W]ith minor adjustments, healthcare would be made more affordable for employees while also cutting down on employer liability."  MORE >>