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Anthem Blue Cross and Children’s Hospital-Orange (CHOC) have reached an agreement under the Commercial Contracting Hospital Agreement, and CHOC will continue participating in the Anthem Blue Cross network. The notice of termination for CHOC has been rescinded. • Children’s Hospital of Orange (053304) • Children’s Hospital of Orange at Mission (053306) For More Information or Help Quoting Anthem, Please Contact Your Dickerson Sales Representative.

Congress recently passed the Pharmacy Benefit Manager (PBM) Reform Act, along with new rules from the Department of Labor proposed to increase transparency in PBM fees. Pharmacy benefit managers have become major cost drivers in health care and this legislation signals a shift towards fairness and affordability for prescription drugs. The PBM Reform Act contains new laws that put consumers first. For commercial plans, these laws include: Full rebate pass-through to plans. Pharmacy benefit managers and their affiliates must forward all rebates, fees and discounts directly to health payers and therefore consumers. Oversight of PBM management services. Pharmacy benefit managers must submit full drug-level reporting to group health plans, reporting on compensation, reimbursements, spread and rebates. Blue Shield has long championed a more transparent and affordable prescription drug system. In January of this year, Paul Markovich, president and CEO of Blue Shield’s parent company Ascendiun, testified at two congressional hearings around healthcare affordability. Blue Shield led the effort to launch CivicaScript in 2020 with the goal of making generic medications available at one clear, consistent, and affordable price. In 2023, Pharmacy Care Reimagined was launched by Blue Shield as a first-of-its-kind initiative that moves away from the traditional PBM model. For More Information or Help Quoting Blue Shield, Please Contact Your Dickerson Sales Representative.

Humana continues to enhance its dental offerings with the launch of its dental cost estimator tool. Available through MyHumana, the dental cost estimator helps members better predict upcoming dental expenses and understand the savings available when visiting an in-network provider. The tool is designed to improve transparency and support more informed care decisions. For More Information or Help Quoting Humana, Please Contact Your Dickerson Sales Representative.

With the 2025 reference year Prescription Drug Data Collection (RxDC) reporting deadline approaching in June, plan sponsors should re-familiarize themselves with the reporting requirements. As of the date of this alert, the reference year 2025 RxDC Reporting Instructions have not been released; however, plan sponsors can use the 2024 reference year instructions (which were for reporting in 2025) as guidance until the new instructions are released. As a reminder, the Consolidated Appropriations Act, 2021 includes a provision that requires group health plans and health insurance issuers (collectively “plans and issuers”) to report certain specified data related to prescription drug and other healthcare spending. The deadline to submit reporting for calendar year 2025 is June 1, 2026 (and continues each June 1st thereafter). Next Steps for Employers In anticipation of the June 1, 2026 deadline, plan sponsors may already be receiving communications from their carriers, TPAs, PBMs and other vendors regarding their expectations for completing the reporting. In our experience, carriers, TPAs, PBMs, and other vendors have varying requirements and expectations of what they need from plan sponsors to successfully complete the reporting, and some may delegate some of the reporting responsibility to the plan sponsor. For example, if your insurance company, TPA, or PBM sent you a survey or questionnaire to collect information about plan numbers, premium, or funding types, it is likely that they are reporting the P2 and D1 files on your behalf. Therefore, we recommend the following: Respond to any requests for information you may receive and coordinate with your vendors to understand their expectations to ensure all reporting is completed in full on behalf of the plan. Note: Some carriers require responses by early March. If your vendor sent you an email or letter asking you to create a HIOS account or stating that they will not submit P2 and D1 on your behalf, that means you must submit P2 and D1 directly to CMS (or engage a third-party to submit them for you). Thus, you and/or a third party submitting P2 or D1 on your behalf will need to follow the RxDC Reporting Instructions and timely complete the submission. To Read Full Alert Click Here

Covered California for Small Business (CCSB) now offers the Initial Payment ACH feature on the MyCCSB portal. This enhancement simplifies the new business process and accelerates group activation. Employers can add ACH payment information during the new business application process eliminating the need to wait for approval before setting up payment. With this enhancement, groups can: • Submit their initial payment sooner • Set up recurring ACH payments for future invoices • Trigger data feeds earlier • Activate members more quickly Please note enrollment information is not effectuated until payment is received and posted to the group's account. Late submission groups submitted and approved beyond the 7th of the month may be subject to withdrawal of the full initial invoice amount including both initial and next month's premium amount. We encourage you to begin using this feature with your new business submissions to help expedite onboarding and activation. For More Information or Help Quoting Covered California, Please Contact Your Dickerson Sales Representative.