Top Takeaways for Employer Plan Sponsors:

Employers will no longer be able to provide low-cost/no-cost telehealth pre-deductible in HDHPs for plan years starting on/after January 1, 2025

Prior to the final CR passage, the House of Representatives released proposed CR text that included a two-year extension of pandemic-era telehealth flexibility for HDHPs. This announcement was welcome news for employer plans – culminating years-long efforts to further extend or make the flexibilities permanent. The Business Group, among others, applauded the extension and continued to make the case for its inclusion. However, in the waning hours of Friday, December 20th (the deadline), it became clear that many provisions sought by various groups (health plan and non-health plan related) were at-risk of being left out of the spending package. Ultimately, the telehealth extension and many other provisions were removed.

While we will continue to seek administrative relief and request that the new Congress (119th) starting early in 2025 restore telehealth flexibility, at this time calendar year plans starting January 1, 2025 should expect to refrain from covering any pre-deductible telehealth items or services (other than preventive) in an HDHP. Non-calendar year plans may continue to provide pre-deductible telehealth into 2025 during the run-out of the current plan year. Absent administrative or congressional action, however, non-calendar year plans should also expect to stop providing any pre-deductible telehealth items or services (other than preventive) in an HDHP for their next plan year (starting after January 1, 2025).

We will keep members updated on efforts to restore the telehealth flexibility and any additional guidance or permission granted by the administration or passed by Congress.

PBM reforms left out of the final CR but discussions continue for 2025 legislation

Pharmacy benefit manager (PBM) reforms were also initially included but abandoned in the CR legislation. The proposed provisions sought to change PBM business practices and requirements around transparency and accountability. For many years, the Business Group has advocated for measures that enhance transparency and accountability within the prescription drug and pharmacy sector while preserving plan sponsors' flexibility to design effective benefit programs and the importance of balancing these transparency efforts with the need for flexibility. (See: Business Group on Health Urges Thoughtful PBM Reform in Congressional Letter).

While a number of the transparency provisions proposed were in-line with reforms the Business Group believes are advisable, the proposal also would have included new civil monetary penalties (CMPs) under ERISA Section 502 that were, and remain, highly concerning. We will continue to work with Congress and the incoming Trump Administration to help secure important improvements and clarifications for employer plans while balancing counterproductive, wasteful administrative and regulatory burden.