"CMS did not finalize the proposal to reinterpret the statutory exclusion of agents when used for weight loss, such that it would not apply to drugs when used for weight loss or chronic weight management for the treatment of obesity ... CMS did finalize: [1] codified Part D provisions in the Inflation Reduction Act (IRA) eliminating cost-sharing for adult vaccines and restricting cost-sharing for a one-month supply of insulin ... [2] established a shortened prescription drug event submission timeline for drugs selected for negotiation under the Medicare Drug Price Negotiation Program."  MORE >>

"[F]ully insured health plans issued, amended, renewed or delivered on or after July 1, 2025 ... [will be required] to provide coverage without cost-sharing for emergency room medical care and follow-up health care treatment for an insured who is treated following a rape or sexual assault for the first nine months after the enrollee initiates treatment.... The law does not apply to self-funded plans."  MORE >>

"A variety of reimbursement arrangements are marketed to employers that purportedly allow them to reimburse employees, on a supposed tax-free basis, for health insurance contributions paid by the employees on a pre-tax basis.... [E]mployers must understand that employers and employees can only take a tax deduction for a health care premium one time. The tax deduction may be taken by either the employer or the employee, but not both."  MORE >>

"The Court concluded that an employer must fail to offer coverage and receive certification under ACA section 1411 of such a failure before the IRS can assess a penalty under IRC section 4980H.... The question before the Court was whether HHS had the authority to delegate the section 1411 notice obligations to the IRS. The Court ruled HHS could not delegate such authority to the IRS and, consequently, the IRS had no authority to penalize the employer in the case before the Court." [Faulk Company, Inc. v. HHS, No. 24-0609 (N.D. Tex. Apr. 10, 2025)]  MORE >>

"Blue Cross Louisiana [approved] mastectomies and breast reconstructions for women with cancer but refused to pay a hospital's full bills.... Blue Cross denied payments for thousands of procedures involved in breast reconstruction. But it approved special deals for treatment for executives' wives.... A jury found Blue Cross liable for fraud and awarded the hospital $421 million. The insurance company denied wrongdoing and has appealed."  MORE >>

"GLP-1 drugs account for 16% of the overall prescription cost for the Rx Collaborative, the largest pharmacy coalition in the U.S., after estimated rebates and discounts ... Recent FDA approvals have expanded indications for cardiovascular risk reduction, sleep apnea and chronic kidney disease. Ongoing trials are investigating conditions, including Alzheimer's disease, alcohol use disorder and metabolic dysfunction-associated steatohepatitis (MASH)."  MORE >>

"Small to midsize businesses (SMBs) represent a sweet spot for this growing marketplace chock full of more meaningful solutions that bypass traditional methods that simply fuel failed approaches.... [Potential solutions] include ditching fully insured plans for greater transparency, control and cost savings in self-insurance, as well as embracing medical stop-loss captives. Other key areas include solving for adverse risk retention, using AI underwriting tools and engaging a new class of third-party administrators (TPAs) that contract directly with providers in a cash-price based network."  MORE >>

"Economic uncertainty may cause some employers to face reducing employee hours or layoffs to cut costs. When downsizing, employers must carefully consider the impact on health and welfare benefits. It's crucial to avoid errors that could have significant implications for both employees and employers. This article explores issues related to workforce reductions and highlights some key employee benefit considerations."  MORE >>

"This proposed rule consists of a range of administrative procedures that clearly lean toward limiting access to ineligible individuals, even at the risk of excluding some who are eligible. The Committee cautions, however, that policies designed to block ineligible individuals can often unintentionally create barriers for eligible individuals as well. Conversely, efforts to guarantee access for all eligible individuals can make it easier for ineligible individuals to receive benefits."  MORE >>

"With affordability pressures mounting -- and growing evidence of overpayment for hospital care -- some states are looking to adopt strategies that limit how much hospitals are paid, typically referred to as 'price caps,' or 'reference pricing.' ... Rather than relying on failed market negotiations, this method offers a transparent and more equitable approach to determining hospital reimbursement rates."  MORE >>

"The [IRS] announced today tax relief for individuals and businesses in the entire state of Tennessee affected by severe storms, straight-line winds, tornadoes and flooding that began on April 2, 2025. These taxpayers now have until Nov. 3, 2025, to file various federal individual and business tax returns and make tax payments."  MORE >>

"As employees' physical, mental and financial health remains a top priority, the strategic use of advanced technology and employee data paves the way to creating more personalised and effective benefit strategies, with a particular focus on the use of AI to support data management, employee support and operational efficiency.  ... [M]ore than half (52%) of multinational HQs consider the use of data-driven insights a high or top priority for enhancing the employee benefits experience."  MORE >>