The National Association of Insurance Commissioners (NAIC) has advised Robert F. Kennedy, Jr., Secretary of the U.S. Department of Health and Human Services (HHS), of their current federal health insurance policy priorities. The NAIC’s recent letter focuses on two major issues: federal health insurance nondiscrimination rules and regulation of prescription drug copayment accumulator programs. Federal Health Read More

Another coalition of congressional lawmakers has united to introduce a new version of the Delinking Revenue from Unfair Gouging Act (DRUG Act) bill. Rep. Marianne Miller-Meeks (R-Iowa) and co-sponsors from both parties introduced the bill, which could impact how pharmacy benefit managers (PBMs) are paid. Miller-Meeks unsuccessfully introduced a previous version of the bill during the 118th Congress. PBMs assist Read More

Two lawmakers from opposite sides of the aisle have revived a version of the pharmacy benefit manager (PBM) reporting bill from the 118th Congress. That bill came close to passage last year but faced criticism from Elon Musk, who ultimately tanked the much larger bill in favor of an abbreviated spending package. Rep. Erin Houchin (R-Indiana), and Rep. Joe Courtney (D-Connecticut), have now introduced the Hidden Read More

Whistleblower Sarah Benke recently testified in a False Claims Act bench trial that Caremark, which is a pharmacy benefits manager (PBM) for Aetna Life Insurance Co., overbilled Medicare Part D for sponsored prescription drugs. She estimated that the CVS-owned PBM caused $240 to $330 million in damages by billing Medicare for reimbursement amounts that were higher than it paid pharmacies for the covered Read More

Large hospitals and health systems have filed a spate of antitrust suits against various Blue Cross and Blue Shield (BCBS) carriers, including Elevance Health and Health Care Service Corp. These plaintiffs in the recent lawsuits are those health system giants that opted out of the $2.8 billion antitrust settlement that BCBS agreed to last fall. They had until March 29, 2025, to reject the settlement and file Read More

The U.S. Department of Health & Human Services (HHS) has issued a memorandum rescinding its 2022 guidance entitled “Rescission of ‘HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy’.” The rescission cites Section 5(b) of Executive Order 14187, “Protecting Children from Chemical and Surgical Mutilation,” as justification. The rescission of the 2022 HHS guidance is effective Read More

The American Benefits Council has released a new white paper calling for reforms to the federal 340B drug pricing program. According to the paper, the 340B program is failing to meet the needs of the patients that it was designed to help. At the same time, the program is driving up healthcare expenses for employer-sponsored health plans by $5.2 billion annually due to a loss of rebates. Furthermore, the program has Read More

The Internal Revenue Service (IRS) has begun the process of implementing the Paperwork Burden Reduction Act, a law from the Biden administration that is already in effect. To assist employers, the IRS has issued Notice 2025-15, which no longer requires employers to send coverage statements to all full-time employees. Instead of sending out complex, personalized statements to full-time employees, employers now can Read More

The U.S. Department of Labor (DOL) has filed a motion with the U.S. Court of Appeals for the Fifth Circuit to pause its appeals of two federal court cases challenging its new Retirement Security Rule. This move follows two July 2024 federal court orders staying the implementation of the rule, which was supposed to go into effect in September 2024. The new Retirement Security Rule extends fiduciary responsibilities Read More

The Office for Civil Rights (OCR), a division of the U.S. Department of Health and Human Services (HHS), has announced a $3 million settlement with Solara Medical Supplies, LLC, a covered entity under the Health Insurance Portability and Accountability Act (HIPAA). The unauthorized disclosures stemmed from a cyberattack that resulted in violations of the HIPAA security and breach notification rules. OCR began its Read More