Insights

On April 4, 2022, in PCMA v. Mulready, the US District Court for the Western District of Oklahoma ruled that the state's Patient's Right to Pharmacy Choice Act (the Act) was not preempted by ERISA and that the state's Insurance Commissioner could enforce it. In 2019, the state legislature passed the Act to regulate PBMs. The PCMA, a trade organization for PBMs, filed suit against the state the same year, claiming that ERISA preempted the Act because it regulated the nature and scope of a plan'

On April 6, 2022, Gov. DeSantis signed HB 459 into law, which restricts step therapy protocols. Step therapy protocol is a medical management process that requires a plan participant to take a certain prescription drug (other than the drug or other course of treatment recommended by his health care provider) or take prescription drugs in a certain order before the plan provides coverage for the recommended treatment. Under existing Florida law, an insurer may not require a step-therapy protoco

On March 14, 2022, a federal district court in the Eastern District of Texas concluded in Coalition for Workforce Innovation et al v. Walsh that the Biden Administration's delay in the implementation and ultimate withdrawal of the Trump Administration's final rule regarding independent contractors (the 'Final Rule') violated the federal Administrative Procedures Act (APA). As a result, the Trump Administration's Final Rule is in effect. As discussed in the January 20, 2021, edition of Complianc

Effective January 1, 2023, Washington state will require rideshare companies such as Uber Technologies Inc. and Lift Inc. to provide paid sick leave for their drivers who are operating in Washington while rideshare drivers remain classified as independent contractors. Eligible drivers in Washington will be able to accrue one hour of paid sick leave for every 40 hours spent driving passengers. Paid sick leave will become available to use after 90 hours of passenger platform time for the ridesha

Join NFP's own Head of Innovation, Mark Rieder, as he discusses what innovation looks like at NFP and how to start your own innovation journey with Naviant's Ema Roloff on their 'Digital Transformation Talks' podcast series. Discussion points include: How to engage a team in innovation How to support continual education within an organization Tips on starting the innovation process Take a listen to hear how innovation gets a strong foundation here at NFP.

In short, yes. A level-funded plan is often viewed as a blended solution for employers that want to switch from a fully insured plan but are not prepared to completely self-insure. An employer sponsoring a level-funded plan pays a set monthly amount to a carrier to cover the estimated cost of anticipated claims, the stop-loss premium and plan administrative costs. If the claim costs are lower than expected at the plan year-end, a refund may be provided to the employer. However, a level-funded

On March 23, 2022, CMS announced an extension of its nonenforcement policy for specific ACA compliance requirements for certain non-grandfathered individual and small group coverage known as 'grandmothered' policies. Under the latest extension, states may permit insurers that have continually renewed eligible grandmothered policies since January 1, 2014, to renew that coverage again for a policy year beginning on or before October 1, 2022. The nonenforcement policy remains in effect until the a

On March 10, 2022, the Wage and Hour Division (WHD) of the DOL published a Field Assistance Bulletin (FAB) (No. 2022-02) to provide guidance regarding worker protections against retaliation under the Family and Medical Leave Act (FMLA), the Fair Labor Standards Act (FLSA), the Migrant and Seasonal Agricultural Worker Protection Act (MSPA), and the Immigration and Nationality Act (INA). Anti-retaliation provisions protect workers who complain to the government or make inquiries to their employe

The US Court of Appeals for the Eighth Circuit recently held, in Pharmaceutical Care Management Association v. Wehbi, that ERISA does not preempt a set of North Dakota laws that impose certain requirements on pharmacy benefit managers (PBMs). This case was before the Eighth Circuit again after the Supreme Court vacated the Circuit's previous finding that ERISA preempted the North Dakota laws and remanded the case for the Circuit to reconsider the case considering the Supreme Court's ruling in R