"Employers must comply with numerous reporting and disclosure requirements in connection with their group health plans." [Chart describes deadlines that occur from March through December, 2025.]  MORE >>

"Without passing additional legislation, current Medicare telehealth flexibilities will expire on March 31, 2025.... With the March 31st deadline fast approaching, key organizations ... are working overtime to raise awareness of the pending deadline and ensuring telehealth remains accessible and viable for both patients and providers."  MORE >>

"It remains to be seen how courts will interpret the regulations as applied to allegations made by plaintiffs. In the meantime, to mitigate risk, plan sponsors may [1] review their tobacco cessation programs and overall wellness platforms for legal compliance, [2] review all communications that describe the tobacco cessation program to evaluate whether the included disclosures regarding the availability of the reasonable alternative standard satisfy applicable regulations, and [3] provide clear, accessible alternatives that allow employees to qualify for the full reward retroactively."  MORE >>

"Over the past year, the ERISA plaintiffs' bar has set its sights on health plans, and more specifically on the question of the high costs of prescription drugs in employer-sponsored health plans.... Given the uncertainty about what new causes of actions may be filed, it is helpful for plan sponsors to understand how PBMs make money from group health plans, the allegations in current lawsuits, potential defenses and ways to help protect against being the next target of the plaintiffs' bar."  MORE >>

"PBM opacity remains a critical issue ... Rebate retention is another common issue.  ... PBMs are often incentivized by the drug manufactures (through rebates and other mechanisms) to promote brand drugs or other expensive drugs over lower cost generics that are equally effective.... Plan Sponsors are obligated to ensure none of the GHP's service provider agreements contain any gag clauses.  ... The legal and fiduciary implications of failing to address these issues are significant."  MORE >>

"EBSA deepened its focus on NQTLs relating to network composition and access. CMS placed a new emphasis on comparative analyses for provider reimbursement treatment limitations and pharmacy benefit formulary design (including step therapy and quantity limits). Many of the comparative analyses focused on prior authorizations, concurrent review, and provider reimbursements."  MORE >>

"Expanding access to services and adding service coverage are key to helping your employees take control of their mental health and well-being.... A great way to educate your employees to better utilize their benefits is through a wellness program that includes incentive-based challenges.... [S]treamline your offering. That could include a benefits smartphone app where you can access all of your plan components, or a one-on-one concierge service acting as a central hub to help employees better utilize their benefits."  MORE >>

"Improving the dissemination of data analytics would help participating providers and could be a way to save substantially on contractor costs ... Accountable care models would benefit from greater patient buy-in ... Ideally, accountable care beneficiaries would have access to digital modes of care, including apps[.]"  MORE >>

"[D]ependent care assistance programs (DCAPs) ... are a valuable tool for attracting and retaining top talent while providing significant tax benefits for both parties involved. This article will explore the advantages of DCAPs and the reasons why employers not presently offering this benefit should potentially reconsider."  MORE >>

"[T]his policy change will have a ripple effect across the entire health care industry ... [This data brief projects] the impact on economies, employment, and tax revenue in all 50 states and the District of Columbia.... Unless Congress extends the enhanced premium tax credits, 4 million more Americans will become uninsured, and many will likely experience difficulties accessing affordable health care."  MORE >>

"Right before the New Year, Congress extended Medicare's telehealth flexibilities for three months ... until March 31. While this move averts an immediate crisis, it fails to address telehealth's long-term uncertainty. These temporary solutions undermine the full potential of telehealth, leaving providers in limbo and patients at risk of losing critical access to care. With permanent policy reform, Congress can unlock telehealth's full clinical and financial potential."  MORE >>

[1] 9th Circuit weighs removing California's nuisance fight with PBMs; [2] 9th Circuit tackles "Jersey Boys" withdrawal liability fight; [3] Northeast Grocery Inc. workers want 2nd Circuit to revive 401(k) excessive fee lawsuit; [4] J&J asks 3rd Circuit to disband talcum powder class; and [5] IBM retirees ask 2nd Circuit to revive pension actuarial equivalence fight.  MORE >>