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Healthcare Third Party Administrators

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

Third Party Administrator & Pharmacy Benefit Manager 2023 Newsletter: TPA & PBM Licensing And Compliance Developments

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Florida OIR Issues Informational Memorandum OIR-23-04M to PBMs - On July 19, 2023, the Florida Office of Insurance Regulation (“OIR”) issued Informational Memorandum OIR-23-04M (“Memorandum”) to Pharmacy Benefit Managers...more

Polsinelli

Third Party Administrator and Pharmacy Benefit Manager Licensing and Compliance Developments

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South Dakota - The South Dakota Division of Insurance (“Division”) recently took regulatory action against a TPA that has held a valid TPA registration in South Dakota since 2006.  In 2021, the TPA submitted its TPA...more

Akerman LLP - Health Law Rx

New Florida Law Will Impose A Third-Party Administrator Licensing Requirement for Pharmacy Benefit Managers

On May 3, 2023, the Florida governor signed a comprehensive law (SB 1550) regarding pharmacy benefit managers (PBMs). This new law imposes significant new requirements on PBMs. This article discusses only one of these new...more

Polsinelli

New York Enacts Legislation Regulating Pharmacy Benefit Managers

Polsinelli on

New York recently enacted legislation, SB 3762, requiring Pharmacy Benefit Managers (“PBMs”) doing business in New York to register and then become licensed with the New York Department of Financial Services (“DFS”).  The law...more

Proskauer - Health Care Law Brief

New York Enacts Landmark Legislation Regulating PBM

On December 31, 2021, New York Governor Kathy Hochul signed landmark legislation to increase the transparency of prescription drug pricing and to establish requirements on pharmacy middlemen. This new law is amongst 100 ...more

Baker Donelson

Buying and Selling Your HUD-Financed Long Term Care Project: Navigating the TPA Process

Baker Donelson on

So you have refinanced your long term care facility with Federal Housing Authority (FHA)-insured financing – a nonrecourse, 30-year (or longer) loan at an amazingly low fixed interest rate. Yes, the process may have been...more

McNees Wallace & Nurick LLC

Feds Define Which “Closely Held Corporations” Are Eligible to Opt Out of Contraception Mandate Under ACA

One year ago, the U.S. Supreme Court ruled in the case of Burwell v. Hobby Lobby Stores, Inc. et al, that for-profit closely held corporations must be permitted to opt out of the Affordable Care Act’s contraception mandate on...more

Manatt, Phelps & Phillips, LLP

Manatt on Medicaid: Montana Governor Signs Act to Expand Medicaid

On April 29, 2015, Montana Governor Steve Bullock signed Senate Bill 405, referred to as the Montana Health and Economic Livelihood Partnership Act (HELP Act), which expands Medicaid to cover an estimated 70,000 new adults....more

Mintz - Health Care Viewpoints

Government Issues New Rules for Religious Employers, But Health Plans, TPAs, and PBMs are still on the Hook to Provide...

The Affordable Care Act (“ACA”) requires that non-grandfathered health plans make preventive care and screenings available to their members at no cost (i.e. no deductibles, coinsurance, or co-payments). The Department of...more

Ary Rosenbaum - The Rosenbaum Law Firm P.C.

Plan Sponsors Should Avoid Using Their Payroll Provider as Their 401(k) TPA

I stick to what I know, so I venture very little outside the retirement plan space. I do that because I believe it is less likely to cause trouble. The two largest payroll providers don’t follow that philosophy -- they are...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Religious Freedom, Contraceptive Services, and The ACA: The Dilemma of the Self-Certification Provision

On February 21, 2014, the Seventh Circuit Court of Appeals, in a 2-to-1 decision, denied a preliminary injunction enjoining the federal government from enforcing the self-certification provisions of the Affordable Care Act...more

Ballard Spahr LLP

HHS and IRS Release Updates on the SHOP Marketplace, Fees, Taxes, and Payment Parameters

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Before departing for the 2013 Thanksgiving holiday, the Obama administration released several new regulatory announcements and guidance relating to the implementation of the Affordable Care Act (ACA). The new guidance delays...more

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