Legally Speaking: Fall Benefits Update
GLP-1 Drugs and Section 1557
Anthem was sued by a group of plaintiffs under 1557 who allege that the plan’s exclusion of GLP-1 drugs for obesity discriminates on the basis of disability. The complaint filed in Holland v Elevance Health Inc * points to coverage of these drugs for a diagnosis of diabetes, but not a diagnosis of obesity (which is a disability under court precedent).
Infertility and Title VII
While the ACA requires large group plans to cover a myriad of services, fertility benefits are largely up to each states’ insurance laws. Plaintiffs in several cases** since 2022 have challenged their employer health plans’ infertility benefits on the grounds of 1557 and Title VII. In one case, Aetna settled with plaintiff, agreeing to change their clinical policy and definition for ‘infertility’ to align with the recent guidelines from the American Society for Reproductive Medicine*** which are more inclusive.
PBM Excessive Fee ‘Win’ for Employers
Last week, the Third Circuit held that employees lacked Article III standing in their complaint filed against MetLife. The plaintiff alleged financial injury, in the form of higher out-of-pocket costs for prescription drug coverage, caused by their employer’s retention of drug rebates. The Court disagreed with this argument, finding it lacked evidentiary support**** Knudsen v. MetLife Grp., Inc., No. 23-2420 (3d Cir. Sep. 25, 2024)
Discrimination Suit Can Proceed to Trial
Law Firm Jones Day is being sued by former attorneys who allege that the parental leave policy discriminates against male employees. The complaint filed back in 2019 states a claim under Title VII of the 1964 Civil Rights Act, and additionally contains retaliation complaints under the Equal Pay Act and DCHRA.
* Holland v. Elevance Health, Inc., No. 24-cv-00332 (D. Me. Sept. 20, 2024)
** Briskin v City of New York et al., No. 24 Civ. 3557 (S.D.N.Y.) , Goidel v Aetna (CASE NO 1:21-cv-07619-VSB-VF), Berton v Aetna (CASE N.: 4:23-cv-01849-HSG)
***Committee opinion published in 2023 to replace the definitions of infertility and recurrent pregnancy loss under the 2020 guidance
****Knudsen v. MetLife Grp., Inc., No. 23-2420 (3d Cir. Sep. 25, 2024)