Health & Welfare Plans Newsletter
November 23, 2020
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[Official Guidance]
229 pages. "The MFN Model will test whether more closely aligning payment for Medicare Part B drugs and biologicals ... with international prices and removing incentives to use higher-cost drugs can control unsustainable growth in Medicare Part B spending without adversely affecting quality of care for beneficiaries.... These regulations are effective on [the date of publication in the Federal Register, currently scheduled for Nov. 27, 2020].... [C]omments must be received ... no later than [60 days after publication in the Federal Register]." [Also see: Fact Sheet
on Most Favored Nation Model; ASPE report
on rises in Medicare Part B drug spending; ASPE report
on Medicare Part B drug spending and international price comparisons; and press release
announcing this rule.] 
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]
[Official Guidance]
345 pages. "Amending this regulation changes the definition of certain conduct that is protected from liability under the Federal anti-kickback statute, section 1128B(b) of the Social Security Act ... New regulatory text in the amendment revises the discount safe harbor. By excluding from the definition of a discount eligible for safe harbor protection certain reductions in price or other remuneration from a manufacturer of prescription pharmaceutical products to plan sponsors under Medicare Part D or pharmacy benefit managers (PBMs) under contract with them, the Department modifies the existing discount safe harbor in particular contexts. Existing safe harbors otherwise remain unchanged. Safe harbors are also created for two additional types of arrangements. The first protects certain point-of-sale reductions in price on prescription pharmaceutical products, and the second
protects certain PBM service fees."
Office of Inspector General [OIG], U.S. Department of Health and Human Services [HHS]
[Guidance Overview]
"Rather than depending for its success on whether private sector firms volunteer for a novel, difficult task, CMS implements the IFR through the existing buy-and-bill model. Under the IFR, providers themselves will be reimbursed for the 50 Part B drugs that are the subject of the IFR program based on the most-favored-nations price.... CMS has now expanded the scope of the program, choosing to implement a mandatory nationwide program affecting most (though not all) Medicare providers."
Rachel Sachs, in Health Affairs Blog
[Guidance Overview]
"The IFR, if it withstands judicial challenge, will restructure prescription drug payments to physicians, hospitals, and other providers and suppliers for the highest expenditure drugs eligible for reimbursement in the Medicare Part B program (commonly known as 'buy and bill' drugs). The [most favored nation (MFN)] Model's actual impact on drug prices, however, remains unclear. Below we describe the key elements of the MFN Model and offer a brief analysis of its potential impact and possible vulnerabilities."
King & Spalding
[Guidance Overview]
"There appear to be no major structural changes between the NPRM and Friday's final rule
(which is now scheduled to take effect in 2022, rather than in 2020, as originally proposed). But there are at least two points worth noting about the new release.... Removing Medicaid Managed Care Organizations ... Changing course by confirming that premiums and spending will not rise ... Like the most-favored-nation rule, the release of the final rebate rule came with additional legal complications that may jeopardize its implementation."
Rachel Sachs, in Health Affairs Blog
"[The cost of] Medicare Part B drugs ... [has] increased by 11.5% over the past five years. Medicare Part B drug spending of $30 billion in 2019 made up 14% of total Medicare FFS Part B spending, up from 11% in 2015. [CMS] is eliminating the Unapproved Drugs Initiative to stop price gouging by drug makers."
HealthLeaders Media
"[H]ow do you know when it's time to consider a new benefits administration solution? ... [1] You rely on paper enrollment and your in-house HR team.... [2] You want to improve your data flow.... [3] You want a more integrated experience.... [4] Your account team isn't able to deliver for your needs today ... or tomorrow.... [5] You want to boost employee engagement."
bswift
" [ IRS Notice 2004-50
] confirms that as long as the requirements are followed, 'there is no time limit on when the distribution must occur.' ... The HSA Shoebox Rule Requirements: [1] The expense was incurred after the HSA was established; [2] The individual keeps records sufficient to later show that the distributions were exclusively to pay or reimburse qualified medical expenses; [3] The qualified medical expenses have not been previously paid or reimbursed from another source; and [4] The medical expenses have not been taken as an itemized deduction in any prior taxable year."
ABD Insurance & Financial Services
"Premium contributions and deductibles in employer plans accounted for 11.5 percent
of median household income in 2019, up from 9.1 percent
a decade earlier. Premium contributions and deductibles were 10 percent
or more of median income in 37 states
in 2019, up from 10 states
in 2010. Nine states have combined costs of 14 percent
or more of median income. The total cost of premiums and potential
spending on deductibles across single and family policies ranged from a low of $5,535 in Hawaii to a high of more than $8,500 in nine states."
The Commonwealth Fund
Press Releases
Most Popular Items in the Previous Issue
Will New Health Care Transparency Requirements Lower Cost and Improve Quality? Epstein Becker Green
Fall 2020 Employee Benefits Briefing Nixon Peabody LLP
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