• California: Apple on Monday released watchOS 11 for its Apple Watch Series 9, Apple Watch Series 10, and Apple Watch Ultra 2, which includes several new health features. One feature is sleep apnea detection using the watch's accelerometer, which detects "small movements at the wrist associated with interruptions to normal respiratory patterns during sleep," Axios writes. FDA has approved the feature as an "over-the-counter device to assess risk of sleep apnea." However, Apple has noted that the feature is not a diagnostic tool and will prompt users to get a formal diagnosis from a healthcare provider if needed. Another feature is a new Vitals app that tracks users' health metrics, including heart rate, respiratory rate, and wrist temperature. If two or more metrics are outside of their normal range, users can receive a notification, along with a message describing how the changes may be associated with other aspects of their lives, such as alcohol consumption or illness. Finally, a Training Load function allows users to measure how the intensity and duration of workouts will affect their body over time. The function also includes an effort rating to track the difficulty of the workout. (Singh, Axios, 9/16 [1]; Singh, Axios, 9/16; Heater, Tech Crunch, 9/16)
• District of Columbia: The Biden administration last week announced plans to finalize a proposal that would require health insurers to cover mental healthcare on the same basis as physical health conditions. Under the new rule, insurers will have to act on analyses they were already required to conduct to ensure mental health conditions are covered the same as others. The rule also prohibits plans from implementing more restrictive prior authorization requirements for mental health compared to physical health and closes loopholes that exempted plans sponsored by state and local governments from the requirements. In statements, President Joe Biden and Vice President Kamala Harris said that the rule was part of broader efforts to help Americans access mental healthcare. "President Biden and I are committed to ensuring that every person in our country has the mental health care they need to thrive," Harris said. "That is why we made the largest investment in youth mental health in history and are transforming how mental health is understood, perceived, and treated for all Americans. Today, we are building on this lifesaving and life-changing work by announcing the finalization of a historic rule that will expand mental health care across our nation so more of our loved ones, neighbors, coworkers, and classmates receive the care they deserve." (Facher, STAT+ [subscription required], 9/9)
• Missouri: On Tuesday, Express Scripts sued FTC over a recent report on PBMs, which it said was "seventy-four pages of unsupported innuendo leveled … under a false and defamatory headline." In July, FTC issued a report that said the prescription drug market is "highly concentrated" since the three largest PBMs are owned by insurers, which in turn own specialty, mail order, or retail pharmacies. According to the agency, these arrangements give PBMs "substantial influence over independent pharmacies by imposing unfair, arbitrary, and harmful contractual terms" that could run them out of business. In its lawsuit, Express Scripts argued that FTC "followed prejudice and politics, not evidence or sound economics, and wrongly concluded that PBMs inflate drug costs and harm independent pharmacies." The company also accused FTC Chair Lina Khan of "anti-PBM bias." In response to the lawsuit, an FTC spokesperson said the agency "stands by our study" and that "… [t]his is a complicated and opaque market, and the FTC is committed to using its clear authority to help the public and policymakers understand it." (Silverman, STAT+ [subscription required], 9/17)

Pharmacy benefit managers (PBMs) play a key role in the U.S. health benefits landscape by facilitating pharmacy transactions and implementing strategies to lower pharmacy costs for insured individuals and their plan sponsors. Download our briefing to learn more about the top five strategies we expect PBMs to focus on in pursuit of increased growth and value.