Compliance
This section focuses on health care compliance and regulations – both national and state – including the ACA. It includes changes in health care law, regulation, and court decisions and their impact on health insurance professionals, employers, and individuals.
The start of the new year brings renewed annual compliance responsibility for employers regarding their health plans, the Affordable Care Act (ACA), and COBRA. Staying informed and proactive in these areas is critical to avoid penalties and ensure compliance. Benefits advisors and insurance brokers play a vital role in helping employers navigate these annual complexities. ...
A group of legislators is calling on the Department of Justice to dig into whether pharmacy benefit managers played a role in the opioid epidemic. The letter (PDF) was sent to Attorney General Merrick Garland last week and was signed by Reps. Buddy Carter, R-Georgia; Raja Krishnamoorthi, D-Illinois; Deborah K. Ross, D-North Carolina; and Cliff Benz, R-Oregon. ...
The Centers for Medicare & Medicaid Services is attempting to cover anti-obesity medications under Medicare Part D and Medicaid, the agency announced Nov. 26. Under the Contract Year 2026 MA and Part D proposed rule (PDF), CMS is choosing to follow conventional medical thinking that obesity is a disease. As such, the agency is then able to ...
The country’s largest pharmacy benefit managers and group purchasing organizations are going on offense against the Federal Trade Commission (FTC). Express Scripts, Caremark and Optum Rx—owned by Cigna, CVS Health and UnitedHealth Group, respectively—are arguing in a new lawsuit the FTC’s recent actions and administrative process subvert the U.S. Constitution by reforming an industry by ...
Unauthorized switching of Affordable Care Act plans appears to have tapered off in recent weeks based on an almost one-third drop in casework associated with consumer complaints, say federal regulators. The Centers for Medicare & Medicaid Services, which oversees the ACA, credits steps taken to thwart enrollment and switching problems that triggered more than 274,000 complaints ...
Those ever-present TV drug ads showing patients hiking, biking or enjoying a day at the beach could soon have a different look: New rules require drugmakers to be clearer and more direct when explaining their medications’ risks and side effects. The U.S. Food and Drug Administration spent more than 15 years crafting the guidelines, which are ...
The Drug Enforcement Administration and Health and Human Services ended an impasse over the virtual prescribing of controlled substances that threatened access to drugs like Adderall by extending pandemic-era flexibilities through the end of 2025. Why it matters: Keeping the status quo leaves the question of whether to make controlled substances available without an in-person doctor’s visit for ...
Former President Donald Trump’s election victory and coming return to the White House will likely bring changes that scale back the nation’s public health insurance programs — potentially increasing the uninsured rate.
A new Trump administration could dramatically alter the Affordable Care Act through either massive changes, technical fixes, or cuts to subsidies and protections.
States may be getting ready to crack down even harder on pharmacy benefit managers. The National Association of Insurance Commissioners will be giving member regulators a crash course on PBM policy next week in Denver, at the NAIC’s fall national meeting. PBMs help health insurers and self-insured employer health plans cover prescription drugs. One NAIC ...