142 pages. "This report to Congress highlights the ongoing efforts of the Departments to strengthen and enforce the protections of MHPAEA ... [along with] the Departments' efforts to raise awareness of the protections of MHPAEA ... and to gather feedback from interested parties on improvements needed and areas of concern. Finally, this report details efforts by the Departments to ensure parity in access to MH/SUD benefits as compared to M/S benefits for participants, beneficiaries, and enrollees, including by issuing the August 2023 proposed rules ... and finalizing those rules with modifications[.]"  MORE >>

14 pages. "This is [OPM's] call for benefit and rate proposals for Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) Program Carriers. This combined Call Letter outlines OPM's policy goals and initiatives for benefit proposals from Carriers in Plan Year 2026."  MORE >>

"The selected drug list for the second cycle of negotiations is: Ozempic, Rybelsus, Wegovy; Trelegy; Ellipta; Xtandi; Pomalyst; Ibrance; Ofev; Linzess; Calquence; Austedo, Austedo XR; Breo Ellipta; Tradjenta; Xifaxan; Vraylar; Janumet, Janumet XR; Otezla."  MORE >>

25 pages, Jan. 16, 2025. "What's New: [1] Preventive care for purposes of qualifying as a high deductible health plan (HDHP) under Section 223.... [2] Expenses treated as amounts paid for medical care.... [3] Health Flexible Spending Arrangement (FSA) contribution and carryover for 2024."  MORE >>

"[T]his Act does not change the distribution requirements for states with individual health insurance mandates ... However, the California rules provide that 'if you have already furnished the federal Form 1095-C to an individual for federal purposes, it is not necessary to provide an additional copy to that individual for California purposes.' ... [It] seems reasonable to take the stance that if an employer provides the Notice of Availability to its employees, it will have satisfied both the federal and California state furnishing requirements."  MORE >>

"The following preventive services, as updated by the new HRSA guidelines, must be covered without cost-sharing for plan years beginning on or after December 20, 2025: [1] Screening and counseling for intimate partner and domestic violence.... [2] Breast cancer screening for women of average risk.... [3] Patient navigation services for breast and cervical cancer screening."  MORE >>

"The agencies have now withdrawn two sets of proposed regulations relating to the contraceptive coverage mandate, avoiding potential nullification of the regulations under the Congressional Review Act and preserving the agencies' ability to propose similar or identical rules in the future."  MORE >>

"The proposed rule would completely overhaul the [HIPAA] Security Rule for covered entities and business associates. The proposed regulations eliminate much of the flexibility offered by the current rules and would involve a multitude of new regulatory requirements for entities dealing with electronic protected health information (ePHI)."  MORE >>

"The NPRM underscores the importance of group health plans being able to recover from security incidents and adapt security measures to new risks and technologies. Most significantly, the proposed rule would eliminate the distinction between 'addressable' and 'required' standards"  MORE >>

"Here are some states have implemented new or expanded leave laws as of January 1, 2025: Connecticut ... Delaware ... Maine ... New York ... [A]dditional changes are on the horizon, including Michigan's Earned Sick Time Act, effective February 21, 2025; Missouri's paid sick leave law, effective May 1, 2025; and Nebraska's paid sick leave law, effective October 1, 2025."  MORE >>

"While the FAQs provide some clarification and guidance regarding the amended rules and processes and procedures in pursuing a private right of action, they also leave some questions unanswered. In addition, the FAQs provide guidance on topics that were not included in the amended rules, including outlining possible additional uses of safe and sick leave that were not explicitly contemplated."  MORE >>

26 pages. "In 2023, 679,156 federal IDR disputes were initiated. ... The total is more than three times the total number of disputes initiated in 2022. Of the disputes initiated in 2023, over 55% were initiated in Q4 alone.... In 2023, providers prevailed in a great majority of the payment determinations (approximately 80%), and a similar majority of selected offers (approximately 80%) were for an amount greater than the QPA." [R48359 Jan. 17, 2025]  MORE >>

"EBSA investigated and closed 102 health plan investigations in FY 2023. Of those investigations, 25 involved fully insured plans, 51 involved self-insured plans, and 26 involved plans of both types ... Of the 102 closed investigations in FY 2023, 51 involved plans or service providers that were reviewed for compliance with MHPAEA. ... EBSA cited 31 MHPAEA violations in 17 investigations.... EBSA benefits advisors answered 196 MHPAEA-related public inquiries, including 183 complaints, in FY 2023. They have answered 1,725 MHPAEA-related inquiries since FY 2011."  MORE >>

"In 2022, it was estimated that 91% of all prescriptions in the United States were filled as generic drugs.... Generic drug prices are consistently lower than brand-name prices across all market sizes and time periods ... The impact of competition on relative drug prices is stable over time: the price reductions are similar for generic drugs first entering the market in the most recent period 2016-2019 compared to both earlier periods, 2007-11 and 2012-15."  MORE >>

"Carrier credits are reimbursements provided by insurance carriers that are designed to offset employee benefits costs.... Carrier credits can come in different shapes and sizes, depending on your group size, plan selections, or renewal agreements. It's smart to check in on potential credits during a few key moments throughout your plan year. It's also important to communicate with your benefits broker on the best plan of action to ensure you're informed about any available credits."  MORE >>

18 pages. "The challenges of 2025 will require employers to be proactive, adaptable and innovative in their approach to employee benefits and healthcare spending, while at the same time remaining vigilant in their fiduciary obligations. The trends and strategies outlined in this report are designed to help guide employers through those processes so that they can effectively manage costs while providing valuable benefits that support and engage their workforce."  MORE >>