The times, they are a changing. And, the lawsuits, they are a coming....
Over the past few weeks, two notable lawsuits have been filed that hold the potential to shape how benefits plans are designed and administered along two very crucial - and costly - aspects of many plans. As these legal battles rage, those of us in the trenches are working to ensure that our partners and their plan members are both educated and protected against these escalating issues.
LAWSUIT #1 - NYC Transit Sues Express Scripts for Fraudulently Managing Their Drug Plan.
"On June 25, 2019, Express Scripts filed a Motion to Dismiss the NYCTA’s Complaint, wherein Express Scripts does not deny that it processed the fraudulent, abusive or excessive claims, but instead seeks to shift the blame from itself to the NYCTA. Surprisingly, Express Scripts asserts in its Motion to Dismiss that the NYCTA’s “lawsuit is a poor attempt to shift blame for NYCTA’s failure to manage and operate its prescription health plan.” The troubling part of this assertion is that Express Scripts is essentially blaming its client, the NYCTA, for failing to do the work it hired Express Scripts to do." You can read the full article here.
Why is this lawsuit important? Employers, advisors, and consultants are gaining increasing knowledge around the practices of traditional PBMs vs transparent ones. As more action comes to light over the growing disparities of business practices between these two camps, employers will ultimately have to determine what their fiduciary responsibility is to their plan members. Here is a cheat sheet outlining 32 common ways traditional PBMs make money that might not be clear to the buyer.
LAWSUIT #2 - AARP Sues Yale Over Their Wellness Program.
Approximately 5400 of Yale University's plan members were required to participate in a wellness program that seems to not be going so well. "The lawsuit argues that by charging some employees $1,300 annually — $25 per week — if they do not to participate in the university's workplace wellness program, Yale has violated both the Americans With Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). The two laws bar employers from getting medical or genetic information from their workers unless that information is provided voluntarily." You can read the full article here.
Why is this lawsuit important? For the past decade, wellness programs have seemed like innocuous "nice to have" benefits for attracting talent while attempting to move the needle on group health. Now that the EEOC has implemented the removal of incentives sections of the Wellness Program Regulations, the floodgates for potential lawsuits are inevitable around the wellness industry. Register for the Validation Institute's webinar on this topic, and learn what mistakes were made that led to this litigation.