"[E]mployers are still required to comply with the Mental Health Parity and Addiction Equity Act, which includes the obligation to have a written Nonquantitative Treatment Limitation comparative analysis as mandated by the Consolidated Appropriations Act, 2021."  MORE >>

"The U.S. Departments of Labor, [HHS], and the Treasury announced ... on May 15, 2025, [that] they will not enforce any new requirements imposed by the [2024 Final Rule] until a final court ruling on a lawsuit filed by the ERISA Industry Committee ... challenging certain provisions of the 2024 Final Rule -- plus an additional 18 months. The Departments clarified that the provisions of the final 2013 [MHPAEA] regulations remain in effect[.]" [ERIC v. HHS, No. 25-0136 (D.D.C. complaint filed Jan. 17, 2025; HHS motion for abeyance filed May 12, 2025, granted May 12, 2025)]  MORE >>

"The comparative analyses of a plan's nonquantitative treatment limitations are statutorily required under the MHPAEA, so plan fiduciaries should continue to prepare comparative analyses, keep them updated, and be ready to provide them upon request by regulators and participants. Plan fiduciaries should continue to ensure nonquantitative treatment limitations are applied no more restrictively for MH/SUD benefits than for M/S benefits in the same classification."  MORE >>

"The first two cycles of the [Medicare Drug Price Negotiation Program (DPNP)] were limited to drugs covered under Part D, but this guidance articulates how CMS will approach potential drug selection and negotiation as the program expands in 2028 to include drugs payable under Part B. In addition, the guidance operationalizes the criteria for selected drugs for a new renegotiation program and the process for renegotiation of the [Maximum Fair Prices (MFP)]."  MORE >>

"Missouri was joined by Alaska and Nebraska in passing a statewide paid sick leave law via ballot initiative in November 2024. Those laws are currently set to go into effect later this year -- Alaska, - effective July 1, 2025; Nebraska, effective October 1, 2025. That said, given the newly clarified fate of the Missouri paid sick time ballot initiative -- i.e., repealed -- it remains to be seen what challenges may await the Alaska and Nebraska laws in the coming weeks as their respective effective dates approach."  MORE >>

"While the reach of Section 1557 in disputes alleging disability discrimination continues to be sorted out in the courts, plan sponsors and their advisors may take some solace in this court's finding that the plan's exclusion of coverage for weight-loss drugs was not alone sufficient to state a plausible claim that the benefit denial was based solely on the presumed presence of a disability." [Holland v. Elevance Health Inc., No. 24-0332 (D. Me. Apr. 9, 2025)]   MORE >>

"While this administration may navigate the prior administrative law issues, several questions must first be addressed, including [1] Definition of 'developed' countries ... [2] Impact on generics and biosimilars ... [3] Framework for direct-to-consumer sales ... [4] Role of pharmacy benefit managers and insurance reimbursement ... Strategic considerations for drug manufacturers include ... [1] Participation in the notice and comment process ... [2] Internal review of drug prices ... [3] Preparing for antitrust scrutiny ... [4] Direct-to-consumer sales ... [5] Negotiations with foreign countries."  MORE >>

"The executive order demonstrates the administration's focus on lowering drug costs for Americans, but there many open questions: Are the MFN prices just for Medicare and Medicaid? How will prices for commercial plans be affected? Does 'facilitate direct-to-consumer purchasing programs' mean expanding the programs in existence today? Will the administration adjust for variances in drug prices due to differences in the health systems of the benchmark countries and the US?"  MORE >>

"While commercial plans are the dominant form of coverage in the U.S., they cover just under 80% of prescription medications for the average enrollee. This means that patients may face the full prescription price at the pharmacy counter for 1 in 5 medications -- even after paying expensive insurance premiums.... 35% of the drugs that are covered are subject to restrictions like prior authorizations and step therapy."  MORE >>

"[The Fair Access for Individuals to Receive Leave Act (HR 3404)] would amend the FMLA by eliminating a provision that limits the total amount of leave available to spouses working for the same employer. If enacted, the change would allow each eligible spouse to take the full 12 weeks of FMLA leave for certain qualifying events."  MORE >>

"Ten years ago, consumers didn't even know what 'cash pay' meant -- there was no need for it. Now, millions of Americans are reliant upon it. We must find ways to make cash prices more accessible and we can start by reimagining what health plans look like. The next-generation of health insurance needs to be fully integrated -- cash prices and funded prices should be ubiquitous."  MORE >>

"In contrast to PBMs, corporate TPA practices remain underscrutinized relative to their importance in the health care system. While TPAs claim to lower medical costs -- similar to PBMs' assertions that they reduce drug costs -- allegations made in litigation suggest this is not often the case.... Based on the growing anecdotal evidence of abuses and increasing profits for the TPA business lines of the nation's largest insurers, examining these TPAs' practices could enable policy makers to pursue reforms that help lower out-of-pocket costs, slow premium growth, and increase wages for workers."  MORE >>

"The OBBB will likely continue to evolve as the bill progresses through the legislative process. [This article provides] a brief overview of some of the most impactful employee benefits items."  MORE >>

"Both large and small employers agreed that they have a responsibility in helping their employees ... Nearly three in 10 small employers cited costs to the employer as a challenge in offering financial wellness initiatives, and nearly one-quarter cited costs to the employee as a challenge.... Smaller employers tended to lag behind large employers in their propensity to offer core, voluntary, and financial wellbeing benefits."  MORE >>