"To the extent consistent with law, the Secretary of [HHS] shall facilitate direct-to-consumer purchasing programs for pharmaceutical manufacturers that sell their products to American patients at the most-favored-nation price.... Within 30 days of the date of this order, the Secretary shall, in coordination with ... other relevant executive department and agency officials, communicate most-favored-nation price targets to pharmaceutical manufacturers to bring prices for American patients in line with comparably developed nations."  MORE >>

"The Secretary of [HHS] will establish a mechanism through which American patients can buy their drugs directly from manufacturers who sell to Americans at a 'Most-Favored-Nation' price, bypassing middlemen. If drug manufacturers fail to offer most-favored-nation pricing, the Order directs the Secretary ... to: [1] propose rules that impose most-favored-nation pricing; and [2] take other aggressive measures to significantly reduce the cost of prescription drugs to the American consumer and end anticompetitive practices."  MORE >>

"BlueCross, serving as both an insurer and fiduciary of an ERISA-governed health plan, denied coverage for fertility treatments to a plan member in New Hampshire. The denial was in accordance with the plan's terms under Tennessee law, which does not require coverage for such treatments. However, New Hampshire law mandates that insurers provide coverage for medically necessary fertility treatments.... The court concluded that the enforcement action was indeed directed at BlueCross in its capacity as an insurer." [Bluecross Blueshield of Tennessee, Inc. v. Nicolopoulos, No. 24-5307 (6th Cir. May 8, 2025)]  MORE >>

"Beach confirms that breach of fiduciary duty and wrongful denial theories grounded in restrictive clinical criteria remain viable post-Wit, while Jones demonstrates how plaintiffs can tailor class definitions to navigate the Ninth Circuit's reprocessing limitations. Collectively, the decisions signal sustained judicial scrutiny of behavioral health guidelines and underscore the importance of robust, GASC-compliant medical necessity criteria and transparent claims communications." [Beach v. United Behavioral Health, No. 21-8612 (N.D. Calif. May 5, 2025); Jones v. United Behavioral Health, No. 19-6999 (N.D. Calif. Apr. 14, 2025)]  MORE >>

"The Trump administration is requesting a D.C. federal court pause an employer group's lawsuit over a Biden-era rule to strengthen mental health coverage as it considers modifying or rescinding the policy." [ERIC v. HHS, No. 25-0136 (D.D.C. complaint filed Jan. 17, 2025; HHS motion for abeyance filed May 12, 2025)]   MORE >>

"[T]wo provisions [of the regulations issued last September] have garnered particular attention: first, that insurers provide 'meaningful benefits' -- as defined by independent medical standards -- for covered mental health conditions if they do so for physical conditions.... Second, insurers must go beyond the written words of their policies to measure how they work in practice." [ERIC v. HHS, No. 25-0136 (D.D.C. complaint filed Jan. 17, 2025; HHS motion for abeyance filed May 12, 2025)]  MORE >>

"The More Paid Leave for More Americans Act (HR 3089) and the Interstate Paid Family Leave Action Network (I-PLAN) Act (HR 3090) reflect a pragmatic, consensus-driven approach to addressing the patchwork of paid leave laws across the country. These proposals are the culmination of more than two years of bipartisan collaboration within the Working Group[.]"  MORE >>

"[1] Develop personalized messaging ... [2] Improve your benefits offerings ... [3] Empower employees to use their claims ... [4] Fine-tune your wellness program and initiatives ... [5] Decrease losses due to claims errors ... [6] Reduce overpaying for avoidable costs ... [7] Predict health care risks and spending."  MORE >>

"It is not a 'price control' when the government reduces the prices Medicare pays for drugs. Price controls are coercive restraints government places on private actors. If Medicare pays less for drugs, by contrast, private actors remain free to buy and sell at whatever prices make them happy."  MORE >>

"[HIPAA's] outdated definitions and narrow scope have created a gaping hole -- one that data brokers, app developers, retail pharmacies, and even your stop-loss underwriter are sprinting through with glee. And the worst part? This data dragnet ... [is] making your health plan more expensive, less accurate, and more vulnerable to being rated and lasered based on guesswork."  MORE >>