News & Analysis as of

Prescription Drug Coverage Health Insurance

Akerman LLP - Health Law Rx

When a Gift Becomes a Kickback: Gifts from Florida Pharmacies to Long-Term Care Facilities

The Florida Board of Pharmacy permits pharmacies serving residents and patients at long-term care facilities (nursing homes, ALFs, homes for DD residents, etc.) as either Special Closed System Pharmacies or Community...more

Holland & Knight LLP

Holland & Knight Health Dose: March 5, 2024

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Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector. ...more

Manatt, Phelps & Phillips, LLP

Executive Summary: Tracking Telehealth Changes State-by-State in Response to COVID-19 - December 2023

S. 3430: Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 Introduced December 7, 202- This bill would require the Secretary of Health and Human Services to: Establish requirements for a code or...more

Polsinelli

Louisiana Insurance Department Fines Express Scripts and Medimpact for Delayed Pharmacy Payments

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The Louisiana Insurance Department (“Department”) recently fined Express Scripts Administrators, LLC (“ESA”) $275,000 and MedImpact Healthcare Systems, Inc. (“MedImpact”) $250,000 for allegedly failing to pay electronically...more

Polsinelli

Florida Proposes New Pharmacy Benefit Manager Rules

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On September 18, 2023, the Florida Office of Insurance Regulation (“OIR”) published proposed rules to implement provisions of the Prescription Drug Reform Act (Florida Senate Bill 1550) governing Pharmacy Benefit Managers...more

Ballard Spahr LLP

Prescription for Chaos: Copay Accumulator Programs Called Into Question

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Summary - Employers taking advantage of copay accumulator programs now face unexpected administrative complications following a recent federal court decision....more

Schwabe, Williamson & Wyatt PC

DJC Op-Ed: Affordable Benefit Ideas to Help Employers Increase Worker Retention

Any employers muddling through the most confounding labor shortage the construction industry has seen in decades probably have already seen dozens of articles with advice on how to best attract, incentivize, and retain...more

Epstein Becker & Green

State Regulation of Pharmacy Benefit Managers: Tenth Circuit Holds That ERISA and Medicare Part D Preempt Key Parts of Oklahoma...

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On August 15, 2023, the U.S. Court of Appeals for the Tenth Circuit (the “Tenth Circuit”) issued its decision in Pharmaceutical Care Management Association (PCMA) v. Mulready, one of the first major opinions to further define...more

Bass, Berry & Sims PLC

Tenth Circuit Rules ERISA Preempts Oklahoma PBM-Reform Law

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In a win for self-funded (i.e., self-insured) health plans subject to the Employee Retirement Income Security Act of 1974, as amended (ERISA), the Tenth Circuit recently ruled that ERISA preempts provisions of an Oklahoma law...more

Robinson+Cole Health Law Diagnosis

Advisory Opinion 22-19: OIG Warns That Proposed Drug Cost Subsidization Arrangement May Warrant Sanctions

On October 5, 2022, the Office of Inspector General (OIG) published Advisory Opinion 22-19 (Advisory Opinion), in which it determined that a proposed oncology drug discount arrangement could constitute grounds for the...more

Bass, Berry & Sims PLC

2022 ERISA Welfare Plan Automatic Participant Disclosures Checklist

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We recognize that many companies sponsor ERISA welfare benefit plans and are currently undergoing their open enrollment process and issuing related participant communications. To assist with that process, we have prepared an...more

Venable LLP

REMINDER: October 15 Is the Deadline for Prescription Drug Notices and the Extended Deadline for Form 5500s

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Does your company's health plan provide prescription drug coverage? If so, you have until October 15, 2022 to send a notice to individuals who are enrolled in Medicare Part A or Part B and are eligible for the company's...more

Jackson Lewis P.C.

4th Quarter 2022 Quick Hits for Plan Sponsors and Administrators

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As we enter the fourth quarter of 2022, sponsors and administrators of employee benefit plans have a lot to juggle. From open enrollment and required notices to plan document deadlines, it is a busy time of year. Yet, there...more

McDermott Will & Emery

Agencies Provide Guidance on Transparency in Coverage Rule Implementation

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On April 19, 2022, the US Departments of Labor, Health and Human Services, and the Treasury (collectively, the Departments) released Frequently Asked Questions (FAQs) regarding the implementation of certain reporting...more

Williams Mullen

PODCAST: Williams Mullen's Benefits Companion - New Prescription Drug and Health Coverage Reporting Requirements

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On this episode of Williams Mullen's Benefits Companion, host Brydon DeWitt discusses the Biden administration’s interim final rule that requires health plans to report prescription drug and health coverage costs and its...more

Mitchell, Williams, Selig, Gates & Woodyard,...

2021 Arkansas Insurance Legislation Summary: Health Insurance

The 93rd Arkansas General Assembly convened on January 11, 2021 and entered into an extended recess on April 27, 2021. The resolution authorizing the extended recess provides for the legislature to reconvene for the following...more

Foley & Lardner LLP

50 State Map of MAC Laws – Can PBMs No Longer Rely on ERISA Preemption to Avoid Certain State Laws?

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Recent court trends suggest that preemption under the Employee Retirement Income Security Act (ERISA) may not apply to certain state laws that regulate pharmacy benefit managers (PBMs), including state laws governing Maximum...more

Faegre Drinker Biddle & Reath LLP

ICER Turns Attention to Health Insurers — New Report Will Examine Whether Plans Provide ‘Fair Access’ to Drugs

On May 12, 2021, the Institute for Clinical and Economic Review (ICER or the Institute) released plans to begin an annual examination into health insurance drug coverage policies to assess “fair access” to prescription drugs....more

Fisher Phillips

Overview Of Employee Benefit Provisions In The Consolidated Appropriations Act

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The Consolidated Appropriation Act of 2021 was signed into law on December 27, 2020 and is an impressive 5,593 pages. According to the Senate Historical Office, the Act is the longest bill ever passed by Congress. Buried...more

Harris Beach PLLC

U.S. Supreme Court Decision Supports State Regulation of Pharmacy Benefit Managers

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The U.S. Supreme Court’s recent unanimous decision clears the way for state regulation of Pharmacy Benefit Managers (“PBMs”). Rutledge v. Pharm. Care Mgmt. Ass’n, 141 S. Ct. 474 (2020). At issue before the High Court was...more

Akerman LLP - Health Law Rx

New Supreme Court Ruling Affirms State Regulation of PBM Reimbursement Pricing

The U.S. Supreme Court ruled against pharmacy benefit managers (“PBMs”) last month, in a decision that marks a major win for state regulators. (See Rutledge v. Pharmaceutical Care Management Association, 2020 WL 7250098 (U.S....more

Locke Lord LLP

Supreme Court Rules ERISA Does Not Preempt Arkansas’ PBM Regulation

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Recently, the Supreme Court released its decision in Rutledge v. Pharmaceutical Care Management Association. The case considers whether the Employee Retirement Income Security Act of 1974 (“ERISA”) preempts an Arkansas state...more

Mintz - Employment Viewpoints

Supreme Court Holds that ERISA Does Not Preempt Arkansas PBM Law: The Impact on Employer Sponsored Group Health Plans

In a recently decided case, Rutledge v. Pharmaceutical Care Management Association, the U.S. Supreme Court held that the Employee Retirement Income Security Act of 1974 (ERISA) does not preempt an Arkansas statute that...more

Groom Law Group, Chartered

The Supreme Court Narrows ERISA Preemption in Rutledge v. PCMA

In the recently-decided Rutledge v. Pharmaceutical Care Management Association (“PCMA”), the Supreme Court found 8–0 (Justice Barrett did not take part) that ERISA did not preempt an Arkansas state law that established...more

White & Case LLP

Supreme Court Green Lights Arkansas Law Regulating PBM Pricing Practices

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On December 10, 2020, the Supreme Court in Rutledge v. Pharmaceutical Care Management Association held that ERISA does not pre-empt an Arkansas law regulating PBM prescription drug payment rates to pharmacies because it...more

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