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Trump Administration Outlines Plan to Put Drug Prices in TV Ads

"For now, the proposal applies only to television ads, but CMS is taking comment on whether disclosure should extend to other forms of marketing, including social media. Some questioned whether the enforcement provisions in the rule have any teeth. Federal regulators would post lists of violators and count on companies to sue each other." American Journal of Managed Care

ftwilliam.com -- Enhanced Welfare Documents Module!

Recent enhancements to our Welfare Plan Documents package provide additional features to our Cafeteria and POP Plan Docs. This includes extensive new options and a new Individually Designed Plan formatted version of the Cafeteria Plan. Learn more!

HHS Announces Drug Price Transparency Proposal, Foreshadows Additional Regulatory Action to Address Drug Prices

"Since July, the White House has been reviewing a proposed rule that purports to modify the federal Anti-Kickback Statute's safe harbor protections for rebates as a means to shift the industry toward a system of fixed, up-front discounts. Secretary Azar encouraged the industry to undertake this transition voluntarily but noted that, as with the DTC advertising proposal, HHS is prepared to take regulatory action to spur industry reform." Sidley Austin LLP

Low Health Literacy: A Concern for Health Insurance Providers and Americans

"More than half of Americans have low health literacy, according to new data from Accenture ... That's just as many people who suffer from some chronic medical problems like obesity.... The inability to use health insurance to access health services leads to delayed care and chronic conditions. Low health care literacy is one of the biggest barriers to preventing and treating heart disease." America's Health Insurance Plans [AHIP]

Express Scripts Covers Amgen, Lilly Migraine Therapies, Excludes Teva Drug

"The new migraine drugs were approved for the U.S. market within a few months of each other this year. That gave Express Scripts more leverage in demanding a discount in exchange for putting a therapy on its 'formulary,' or list of covered drugs.... All three drugs have a list price of $575 a month, or $6,900 a year." Reuters

HHS Increases Civil Money Penalties for HIPAA Noncompliance

"The adjusted penalty amounts apply to penalties assessed on or after October 11, 2018, if the violation occurred on or after November 2, 2015 ... [A] table reflects certain of HHS's annual inflation adjustments to the civil money penalties for HHS-administered provisions, effective October 11, 2018." Thomson Reuters Practical Law

Anthem's $16 Million HIPAA Settlement Is Largest in History

"HHS has begun providing tools for addressing cyber attacks, though in some ways these resources are geared more toward incident response than to preventing an attack in the first place.... In the Anthem settlement, HHS focuses on at least two compliance shortfalls that contributed to the breach -- not conducting a thorough risk analysis of potential risks to ePHI and not regularly reviewing records of information system activity." Thomson Reuters Practical Law

Bad Debt Grows as Out-Of-Network Benefits Shrink

"[T]he proportion of plans with OON benefits has declined from 58% in 2015 to 29% in 2018 in the individual market ... [E]ven plans that do offer OON benefits increasingly have very high deductibles and maximum out-of-pocket (MOOP) caps.... [In] the individual market, the median OON deductible is approximately $12,000 ... Some are even higher." HealthLeaders Media

Second Circuit Speaks on When Ministerial Acts Can Breach a Fiduciary Duty

"The Second Circuit affirmed summary judgment to the pension plan on the basis that the SPD clearly and unambiguously provided ... accurate information ... [But] the court found the welfare plan SPD lacking in its organization, presentation, and substance: ... The Second Circuit concluded that the 'almost impenetrabl[e]' language, coupled with the petitioner's reasonable misunderstanding of a comment by a claim specialist concerning the availability of health benefits, presented a question of material fact sufficient to defeat summary judgment." [ In re DeRogatis , Nos. 16?977-cv, 16?3549-cv (2d Cir. Sept. 14, 2018; unpub.)]
Robinson & Cole LLP

HIPAA and Accounting Cybersecurity Update

"The SEC had been investigating 9 publicly traded companies who became victims ... The fake vendor scams were emails from company vendors (following hacking into vendor systems) requesting payment to the vendors but directing the funds to non-vendor accounts.... [Two of the companies] lost in excess of $30 million and all 9 in total lost nearly $100 million. Because HR requires the use of a number of vendors to deliver benefits, it is important that all of the HR department personnel be alert when reviewing email requests for payment." Winstead PC

2018 Small Business Benefits Study

"4 in 10 small business workers depend on their workplace benefits for financial security. Higher out-of-pocket medical costs impact workforce well-being. Small businesses are addressing workforce health with wellness initiatives and flexible work arrangements. People want to work for companies that care." Guardian

Employees Decrease Retirement Savings and Financial Wellness Due to Health Costs

"Approximately one-half of workers (47%) report having experienced an increase in health care costs in the past year, about the same percentage since 2015. Of those reporting cost increases, 24% state they have decreased their contributions to retirement plans, and 41% have decreased their contributions to other savings. Thirty percent have delayed retirement, and 17% have taken a loan or withdrawal from a retirement plan." planadviser

Press Releases

Ascensus Acquires ESOP Economics Ascensus

OCR and ONC Bolster the Security Risk Assessment (SRA) Tool with New Features and Improved Functionality U.S. Department of Health & Human Services

Hub International Acquires the Assets of Oklahoma-Based Jones Retirement Plan Advisors HUB International

Federal Court Appoints Successor Fiduciary to Oversee Distribution of $46,371 to Participants of Abandoned Profit Sharing Plan Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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Most Popular Items in the Previous Issue

2018 Welfare Plan Participant Disclosure Checklist (PDF) Bass, Berry & Sims

HHS Fact Sheet: What You Need to Know about Putting Drug Prices in TV Ads U.S. Department of Health and Human Services [HHS]

Anthem Pays OCR $16 Million in Record HIPAA Settlement Following Largest U.S. Health Data Breach in History U.S. Department of Health and Human Services [HHS]