"Annual reporting is required by June 1 of each year. Calendar year 2023 data reporting is due June 1, 2024. Most employers sponsoring group health plans that provide prescription drug coverage, regardless of size or funding (fully insured or self-funded), have some role to play in the RxDC process.... [This article provides] a refresher on the RxDC reporting requirements and responsibilities."   MORE >>

27 presentation slides. Topics: [1] Washington update; [2] Update regarding STLDI and fixed indemnity regulations, and IRS News Release IR 2024-65 ; [3] Considerations for group health plan service agreements in light of recent legislation, regulation and litigation; [4] Drug importation issues; and [5] HIPAA developments.   MORE >>

"The risk analysis ... must address all ePHI across the entire enterprise and identify deficiencies in compliance programs when compared to the HIPAA security rule. Based on the results of the risk analysis, the risk management plan is created to determine what safeguards need to be implemented to bring the identified risks and vulnerabilities to a reasonable level."   MORE >>

"While the entire ACA preventive coverage framework is before the court, the oral arguments focused entirely on two issues: the constitutionality of the appointments of members of the Task Force and the appropriate remedy should the court side with the plaintiffs.... The government also advanced arguments suggesting that Secretary Becerra's retroactive ratification of all Task Force recommendations and subsequent reappointment of its members resolved any remaining constitutional defects. The court seemed skeptical on the latter point." [ Braidwood Management, Inc. v. Becerra , No. 20-0283 (N.D. Tex. Sep. 7, 2022; on appeal to 5th Cir. No. 23-10326)]   MORE >>

"As a major drug maker itself, certainly J&J is presumed to understand the prescription drug market and industry practices. For companies using PBMs to provide prescription drug benefits to employees and beneficiaries, this complaint must serve as a warning ... [T]his lawsuit is likely to spark significant interest into the opaque world of prescription drug plans and their pricing, which will undoubtedly lead to additional lawsuits." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]   MORE >>

"HSA balances continued to increase over the course of the year, despite higher spending on health care.... Accounts that received an employer contribution saw higher total contributions and were more likely to invest.... Most accountholders took a distribution in 2022.... Relatively few HSAs are invested.... Age and tenure play a major role in HSA utilization."   MORE >>

"Last year's peak inflation rates will affect the health care sector in 2024 as multiyear contracts expire. Utilization remains high as Americans continue to catch up on nearly four years of treatments they may have missed or deferred during the pandemic.... Demand for pricey specialty drugs such as GLP-1s for weight loss will further drive up costs across the industry. New regulations aimed at providing more transparency from pharmacy benefit managers and carriers will add to the administrative burden."   MORE >>

"The American Hospital Association calls the suspected ransomware attack on Change Healthcare, a unit of insurance giant UnitedHealth Group's Optum division, 'the most significant and consequential incident of its kind against the U.S. health care system in history.' While doctors' practices, hospital systems, and pharmacies struggle to find workarounds, the attack is exposing the health system's broad vulnerability to hackers, as well as shortcomings in the Biden administration's response."   MORE >>

"The Department of the Treasury and the [IRS] invite the public to submit recommendations for items to be included on the 2024-2025 Priority Guidance Plan.... The 2024-2025 Priority Guidance Plan will identify guidance projects that the Treasury Department and the IRS intend to actively work on as priorities during the period from July 1, 2024, through June 30, 2025."   MORE >>

"Common areas [for] fiduciary breaches include [1] plan sponsors failing to timely remit employee contributions to the plan, particularly for off-cycle and manually cut checks; [2] plan committees not using best practices to monitor, choose, and remove plan investments and not properly benchmarking performance and fees; and [3] plan fiduciaries relying heavily on third-party administrators to process claims without reviewing the claims letters and/or procedures being used by the third-party administrators."   MORE >>