Health & Welfare Plans

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Seyfarth Synopsis: Arkansas has become the first state in the nation to enact legislation, effective starting in 2026, prohibiting pharmacy benefit managers (PBMs) from owning or operating actual pharmacies within the state. We take a look at what that may mean for employers sponsoring health plans with pharmacy benefits in the state.

Background on PBMs Role in the Marketplace

PBMs have become a unifying scapegoat in the escalating concern about the cost of prescription drug coverage in the country. So, it becomes important to understand what role they really play. PBMs act as a middle man of sorts for the prescription drug coverage offered by many employer health benefit plans. With the ever-expanding universe of prescription drugs, including the many specialty drugs that are being offered and widely advertised to the public, it is difficult for plan sponsors to be able to directly manage this benefit. PBMs grew up as an answer to the needs for a third party to administer drug coverage under plans. 

Continue Reading Cutting Out the Middle Man
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Seyfarth Synopsis: On January 17, 2025, the U.S. Departments of Treasury, Labor and Health and Human Services (the “Agencies”) released its annual report to Congress assessing compliance with statutory mental health parity requirements under the Mental Health Parity and Addiction Equity Act (“MHPAEA”). On the same day, a federal lawsuit was filed against the Agencies challenging the recently published final rule governing MHPAEA compliance (the “Final Rule”).

Each year since the passage of the Consolidated Appropriations Act, 2021, the Agencies have published a report to Congress detailing widespread noncompliance with the MHPAEA rules governing non-quantitative treatment limitations (“NQTLs”), providing examples of problematic NQTLs, and outlining related corrective actions enforced by the Agencies. This year was no different. In January, the Agencies’ annual report to Congress identified common NQTLs and how to address them, focusing primarily on certain key priority areas such as mental health and substance use disorder benefit exclusions, prior authorization requirements, and network composition issues. For example:

Continue Reading Federal Lawsuit and Tri-Agency Report Shake Up Mental Health Parity
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Seyfarth Synopsis: Recently HHS issued a memorandum announcing the maximum annual limitation on cost sharing (a/k/a out-of-pocket maximum) for 2026 and the IRS issued Rev. Proc. 2024-40 announcing the cost-of-living adjustments to certain welfare and fringe benefit plan limits for 2025.

2026 Out-of-Pocket Maximum

On October 8, 2024, the Department of Health and Human Services…

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Seyfarth Synopsis: On September 9, 2024, the Departments of the Treasury, Labor, and Health and Human Services (the “Departments”) released highly anticipated Final Rules under the Mental Health Parity and Addiction Equity Act (MHPAEA).  Instead of providing the guidance hoped for by stakeholders, the new rules may leave employers wondering if they should continue to…

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On Monday, September 9, 2024, the Departments of Health and Human Services, Labor and Treasury (the “Departments”) issued their final rule regarding the nonquantitative treatment limitation (NQTL) comparative analysis required under the Mental Health Parity and Addiction Equity Act (MHPAEA). (These acronyms roll right off the tongue, don’t they?) The Departments note that final rules…

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Seyfarth Synopsis: The IRS has announced increases to key limits for certain health and welfare benefit programs, including HSA contributions for 2025.

The IRS recently released 2025 cost-of-living adjustments applicable to dollar limitations for certain employer-sponsored health and welfare plans in Rev. Proc. 2024-25.

The changes in the 2025 cost-of-living adjustments for employer-sponsored health…

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Seyfarth Synopsis: Following years of back and forth, new final rules were published by the Department of Health and Human Services (HHS) on May 6, 2024 reinstituting the Department’s interpretation that the prohibition on discrimination by health programs and activities “on the basis of sex” includes treatments for gender-affirming care. In this post, we explore…

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This post was originally published to Seyfarth’s Global Privacy Watch blog.

Seyfarth Synopsis: This past Monday, the Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) issued its final rule aimed at strengthening the HIPAA Privacy rules as they are applied to reproductive health data.

On the heels of the release of the 2022 US Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, the Biden Administration directed the Federal agencies to examine what they could do to protect women’s health and privacy. Shortly thereafter, HHS released guidance under HIPAA related to reproductive health care services under a health plan, focusing on information required to be disclosed by law, for law enforcement purposes, and to avert a serious threat to health or safety (see our earlier Alert here). Then, in April 2023, HHS issued proposed modifications to the HIPAA Privacy Rule aimed at these concerns. A year later, the agency finalized those rules on April 22, 2024 – the Final Rule.

Continue Reading HHS Strengthens HIPAA Rules to Protect Reproductive Health Privacy