New York to Finalize PBM Regulation

December 10, 2024

EGWP marketplace medicaid Medicare

The New York Department of Financial Services (DFS) has released final regulations implementing a 2022 PBM licensure law. According to DFS, this regulation will be officially finalized and effective upon its publication in the state register on Nov. 27. The final regulation follows DFS’ 2023 release of proposed regulations, which were ultimately withdrawn following vocal opposition from many Express Scripts clients.

Fortunately, the worst provisions from the 2023 proposed regulation, such as the $10.18 dispense fee mandate, network restrictions, and frozen formulary requirements, are not included in the final regulation. However, some problematic provisions remain including state regulation of ERISA and Medicare, provisions jeopardizing certain types of pharmacy networks, member communication restrictions, and pharmacy audit restrictions.

Over the last year, State Government Affairs initiated multiple client activation campaigns resulting in numerous clients, including New York City organized labor entities, voicing opposition to the proposed regulations. This opposition was instrumental in taking a catastrophic proposed regulation and molding it into something much less impactful.

legislation

Congress Stares Down Dec. 20 Deadline to Extend Federal Funding

Congressional leaders are reportedly planning to extend current federal funding via a continuing resolution (CR) for a short period of time into 2025. This would set up another funding deadline for the incoming Trump Administration to negotiate early in the year. There is also a concurrent negotiation regarding which policies will be “attached” to the […]
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December 10, 2024

EGWP marketplace medicaid Medicare

survey results

HHS OIG Report Finds Half of Hospitals Fail to Comply with Transparency Law

A new report by HHS’s Office of Inspector General (OIG) finds widespread failure among hospitals to comply with federal price transparency law, with almost half of 100 surveyed hospitals not fully compliant. The report found that many hospitals are not publishing their prices in accordance with the law, with some hospitals saying they would rather […]
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December 10, 2024

medicaid Medicare

legislation

Energy and Commerce Chair Sends Letters to FTC, Four Other Agencies to End Partisan Work

On Nov. 6, House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) sent letters to five federal agencies, including the Federal Trade Commission (FTC), urging the Biden-Harris administration appointees to abandon partisan efforts. She noted that the election results mean the agency leadership will soon change and, “As a traditional part of the peaceful […]
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December 10, 2024

EGWP marketplace medicaid Medicare

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