Cigna, one of the largest health insurers in the country, is set to acquire pharmacy benefit manager Express Scripts (ESI) in a cash and stock transaction valued at approximately $67 billion. The proposed deal has Cigna acquiring ESI at a 31% premium and is expected to close by the end of 2018.
One hundred million Americans have diabetes or pre-diabetes and newly diagnosed cases have tripled over the past 20 years. As the seventh leading cause of death in the United States, diabetes is characterized by inadequate insulin secretion resulting in high blood sugar and potential long-term heart, kidney, eye or nerve complications. Along with the rise of newly diagnosed cases, there has been a sharp increase in the cost of medication, presenting a challenge for many diabetic patients and their employers.
Yesterday, Congress voted to pass H.R. 195, a bill that will continue to fund the government through February 8, 2018. The bill was signed by the President last night and it includes three items specific to the Affordable Care Act, two of which will impact employer-sponsored coverage directly:
On December 20, 2017, the U.S. District Court for the District of Columbia vacated key provisions of the Equal Employment Opportunity Commission’s (EEOC) final rules for employer-sponsored wellness programs. However, to avoid disruption to employers, the court stayed its ruling until Jan. 1, 2019.
The HIPAA nondiscrimination regulations aren’t new to most employers with wellness programs. Employers who offer health-contingent wellness programs are especially familiar with the requirement to provide a reasonable alternative standard as part of their wellness program compliance.
Currently, a pending district court case, Secretary of Labor v. Macy’s, Inc. et al, has placed a greater focus on the reasonable alternative standard portion of the HIPAA nondiscrimination regulations. This focus is specific to health-contingent wellness programs that are outcomes based. These wellness programs require individuals to attain or maintain a certain health outcome (or outcomes) to receive a reward. A tobacco health plan premium surcharge is one example. Although this is an active case, with no official judgements or rulings, the flag has been raised by the Department of Labor specific to the reasonable alternative standard and outcomes-based programs.