438 pages. "In this final rule, CMS codifies certain Part D requirements from the Inflation Reduction Act of 2022 (IRA). Specifically, this rule codifies the IRA's vaccine and insulin cost-sharing requirements and codifies the program instruction for the Medicare Prescription Payment Plan program. Additionally, CMS is finalizing two IRA-related provisions that are needed to help ensure that selected drugs with maximum fair prices (MFPs) in effect under the Negotiation Program are available to beneficiaries at the point of dispensing and that the MFPs are effectuated for dispensing entities timely." [Also available: Fact Sheet]  MORE >>

Apr. 4, 2025. "Did you pay premiums during your tax year for employee health insurance coverage you provided through a Small Business Health Options Program (SHOP) Marketplace (or do you qualify for an exception to this requirement)? ... See the instructions and complete Worksheets 1 through 7 as needed."  MORE >>

"As outlined by the CMS, the Trump administration's final rule will not include three proposals included in the initial proposal, including the plan to cover anti-obesity medications. The previous administration attempted to have Medicare Part D and Medicaid cover anti-obesity drugs under the Contract Year 2026 MA and Part D rule, which would have substantially increased access to GLP-1 drugs for weight loss. (Some other indications are currently permitted.)"  MORE >>

"The earned paid sick time provisions of Proposition A are set to take effect on May 1, 2025.... The law applies to almost all Missouri employees, including full-time, part-time and temporary with limited exceptions.... While ongoing litigation and legislative efforts seek to delay or modify certain aspects of the law, these initiatives are unlikely to affect the start date or the notice period required by the statute."  MORE >>

"McKee challenged a related provision requiring PBMs to admit any willing pharmacy to their networks without giving preference to a pharmacy or requiring different cost-sharing obligations or additional fees for using a certain participant-preferred pharmacy.... After rejecting standing challenges by Tennessee, the court found that the challenged provisions were preempted by ERISA because they have an impermissible 'connection with' ERISA plans[.]" [McKee Foods Corporation v. BFP Inc., No. 21-0279 (E.D. Tenn. Mar. 31, 2025)]  MORE >>

"This decision underscores the reliance on subjective medical evidence in ERISA disability claims, particularly for conditions that are not objectively verifiable. It also highlights the necessity of scrutinizing plan terms and insistence on objective evidence where none is required or feasible, reaffirming the role of treating physicians' opinions in substantiating disability claims." [Waldron v. Unum Life Ins. Co. of Am., No. 24-5193 (W.D. Wash. Mar. 28, 2025)]  MORE >>

"If a broker or consultant comes to you with a solution that claims that it can remove an employee from an employer-sponsored health plan because of high claims or suggests that a high claimant will be 'dropped' from coverage in exchange for another solution, it's a red flag. These kinds of promises may sound tempting, but they often fall short of legal standards and may violate HIPAA and Medicare nondiscrimination rules, as well as other IRS rules."  MORE >>

"[The April 2] hearing highlighted how growing health insurance premiums are straining employers -- especially small businesses -- and explored policy solutions to help keep coverage both accessible and financially sustainable."  MORE >>

"Among large employers (500 or more employees), the highest average rating was for allowing the use of HSA funds for long-term care services ... After that, employers were most likely to strongly support allowing telemedicine and mental health services to be covered pre-deductible without interfering with HSA eligibility, and higher annual HSA contributions limits."  MORE >>

"[T]he only real power employers have is to exit the cartel altogether. Self-fund your health plan. Get out of the network. Strip these middlemen of the leverage they use to fleece you, your employees and their families. Because when you carve out the networks, the contracts, and the opacity, you expose the real costs.... And, maybe most importantly, you stop buying Champagne for the folks who think your sick employees are actuarial rounding errors."  MORE >>

"Although minimizing administrative costs is not the goal of the health care system, the fiscal burden of administration, and associated frustration, may make our system hard to sustain, motivating calls for reforms. [This article describes] the challenges inherent in health care markets and how our approach to addressing those challenges contributes to high administrative costs.... [M]odest policy-based guardrails can help mitigate administrative costs while maintaining the structure and values of our system."  MORE >>

"The 2025-2026 Priority Guidance Plan will identify guidance projects that the Treasury Department and the IRS intend to actively work on as priorities during the period from July 1, 2025, through June 30, 2026.... Please submit recommendations for guidance by Friday, May 30, 2025, for possible inclusion on the original 2025-2026 Priority Guidance Plan."  MORE >>