Federal Courts Delay New Healthcare Nondiscrimination Rules
On July 15, 2024, federal judges delayed parts of the Biden Administration’s new healthcare nondiscrimination rules, which were set to enforce Section 1557 of the Affordable Care Act starting July 5, 2024. These rules, reversing Trump-era regulations and restoring Obama-era provisions, broaden the definition of sex discrimination to include pregnancy, sexual orientation, gender identity, and sex characteristics. Judges have paused implementation due to claims that the rules overreach and violate the Administrative Procedure Act, with injunctions affecting enforcement in Mississippi, Florida, Texas, and Montana. This shift in judicial standards, which reduces deference to federal agency interpretations, may delay full implementation for years and impact future health policy litigation.
Pennsylvania Enacts Telemedicine Coverage and Advances Key Health Bills
On July 8, 2024, Pennsylvania advanced several key health policy measures. Governor Shapiro signed a law requiring insurers to cover telemedicine services starting October 3, 2024. House Bill 2234 proposes a $50 million investment in the state’s reinsurance pool to subsidize insurance for lower and middle-income residents, which aims to lower premiums across the individual market.
Cigna Expands Gene Therapy Coverage
Cigna is a pioneer in expanding gene therapy coverage with its Embarc Benefit Protection program. This solution aims to make high-cost, life-changing treatments more accessible and affordable for both patients and employers by offering a network solution with a predictable monthly fee. As gene therapy advances, Cigna plans to include more treatments in the program, removing contractual limitations on existing ones, and sharing potential cost savings with clients. This initiative demonstrates Cigna’s commitment to addressing complex health challenges and improving patient outcomes.
Digital ID Cards Coming to UnitedHealthcare
UnitedHealthcare is transitioning to digital medical ID cards for plan subscribers who have chosen paperless communication. Starting July 31st, these subscribers will receive a digital ID card accessible through the UnitedHealthcare app or website, eliminating the need for physical cards. They’ll be notified via email and can opt-out of digital cards if needed. New members and those in specific states or plans will still receive physical cards.
Governor Shapiro Signs PBM Reform Law
On July 17, 2024, Pennsylvania Governor Josh Shapiro signed a law to regulate pharmacy benefit managers (PBMs) for fully insured health plans, effective November 14, 2024. The law bans mandatory use of mail-order or affiliated pharmacies, restricts auto-enrollment to maintenance drugs after 90 days, and requires pharmacies to charge no more than the cash price or reimbursement amount. PBMs must meet Medicare standards, cannot label drugs as specialty unless specified, must pass 95% of manufacturer rebates to health plans, and will face transparency requirements with annual reporting to the Pennsylvania Insurance Department starting in 2026.
Compliance Corner! Delaware’s New PFML Program
Delaware’s Healthy Delaware Families Act, passed in May 2022, introduces Paid Family and Medical Leave (PFML) for workers, effective January 1, 2026. This program mandates up to 12 weeks of job-protected paid leave for eligible employees facing serious health conditions, bonding with a new child, or other significant family needs. Employers with 10-24 employees are eligible only for bonding leave, while those with 25 or more employees also offer family or medical leave. Funded by payroll contributions, the program allows private plans with equal or better benefits. Weekly benefits cover 80% of average wages, capped at $900. Employers can integrate PFML with other employer sponsored benefits to enhance coverage.
Rob is an employee benefits expert with over 25 years of experience. He is the founder and principal of Precision Benefits Group, a leading provider of corporate benefits plans. He is a member of the Philadelphia Business Journal Leadership Trust and regularly contributes to the publication.