Gag Clause Attestation Due December 31, 2025

Aris Herrera

As previously reported, insurance carriers and plan sponsors of group health plans must submit information annually to the Centers for Medicare and Medicaid Services (“CMS”) attesting that their plans do not include prohibited gag clauses by December 31st each year. The next attestation is due by December 31, 2025. A gag clause is a contractual term that directly or indirectly restricts specific data and information that a plan or issuer can make available to another party. These clauses may be found in agreements between a plan or carrier and any of the following parties: A gag clause may also be found in the downstream agreements of the service provider. Carriers and… Read More

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IBC’s Latest Updates: Weight Loss Drug Policy

Ed MacConnell

The International Benefits Consortium (IBC) has recently revamped its weight management medication coverage, responding to the FDA’s approval of Zepbound—a potent combination of GIP and GLP-1 receptors. This aligns Zepbound with existing options like Wegovy® and Saxenda® under IBC’s coverage criteria. Key Points: Weight Loss Drug Policy Update: IBC’s weight loss drug policy now includes Zepbound, showcasing their commitment to staying current with pharmaceutical advancements and ensuring robust coverage options for members. CAA Gag Clause Attestation: Addressing transparency concerns, IBC acknowledges the CAA’s impact on healthcare communication by eliminating “gag clauses” that restrict information exchange between providers and patients. Healthy You Program Options: IBC introduces new program options for self-funded… Read More

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