The legal fate of the Patient Protection and Affordable Care Act (PPACA) is poised to take center stage at the nation's highest court in the next few months.

The Supreme Court recently agreed to consider a number of lawsuits pertaining to PPACA and likely will start hearing arguments in March, with a final ruling expected in June, according to a report in Employee Benefit News.

The full impact of a ruling against PPACA will depend on whether the court strikes down the entire law or only sections of it. In fact, a partial ruling might create some big problems, according to Diane Boyle of the National Association of Insurance and Financial Advisors.

"If the court strikes down the individual mandate while leaving the law's other provisions intact, it could create havoc in the health insurance marketplace," Boyle told EBN. "[The] lack of a mandate would mean individuals would have no incentive to seek health insurance until after they become injured or sick. If only sick and injured people are buying insurance, clearly that's not sustainable."

As long as the law's future remains unclear, employers are stuck in limbo regarding the main provisions of the legislation that are set to start in 2014.

One provision of the law that was initially welcomed by employers -- and that is effective now -- is a special tax credit for small businesses. However, the government's effort to tout this benefit is falling short of expectations, according to a report by CCH. The government reported that about 228,000 small employers claimed more than $278 million in tax credits in the law's first year. That's far short of the estimated 4.4 million taxpayers who could possibly qualify for the credit.

William Dennis, a research fellow at the National Federation of Independent Business Research Foundation, told Bloomberg BusinessWeek that the low numbers are not surprising, arguing that the idea of the tax credit was simply "a talking point for political reasons; it wasn't a serious thing."

White House officials deny that charge and counter that few businesses accessed the credit because most companies weren't able to adjust employee coverage in time to take advantage of it yet. 

Still, others complain that the rules regarding the credit and eligibility are so confusing that most employers don't understand it and don't have the time or resources to sort it out, according to the BusinessWeek report.

Although the federal government has pledged to increase education efforts, it might all become moot if the right-leaning court throws out the law. However, the tax credit might survive the court's moves, even if other provisions are tossed.

No matter which way the court rules, it will create some level of burden on employers, Keith R. McMurdy of N.Y.-based Fox Rothschild told EBN. "It will cause a significant rippling throughout what we've done the last two years either way," he said.

Soaring health costs from hospital stays, emergency room charges and doctor's appointments -- costs that often are out of employers' control -- all give sponsors of benefit plans plenty to worry about these days.

Fortunately, many employers are making a real impact in one area that is increasingly important when figuring total health costs: prescription drugs.

A new report by the Pharmacy Benefit Management Institute notes that employers are actively taking measures to shore up and control their prescription drug benefits with some success, according to Human Resource Executive Online.

Specialty drugs -- high-cost medicines that can reach hundreds of thousands of dollars annually for a single patient -- have become a main target, the report notes. While copays for generics and traditional drugs have remained stable, specialty copays increased 37 percent between 2010 and 2011 and are expected to jump more in the future.

Although only about 3 percent of employees take these types of drugs, the prescriptions account for as much as 15 percent of overall drug costs, Doug Ghertner, president of Change Healthcare, told HREO.

Some other emerging strategies include:

More Cost-Sharing
Making employees aware of the real cost of prescriptions can influence behavior and persuade workers to use cheaper generics, Ghertner said. Cost-sharing drives home the value of the benefit for employees and can lead to better decisions at the pharmacy counter, he said.

Drug Adherence
Patients who don't take their medicines properly can create more health problems down the road, experts say. Joshua Brenner, a doctor of pharmacy, noted at a recent industry summit in Washington, D.C., that guidance directly from a pharmacist or health professional can significantly boost drug adherence. In a report by Drug Topics magazine, Brenner said personalized communications and targeting high-risk patients for nonadherence also is key.

Integration
More employers are exploring the idea of merging the prescription portions of their group health and worker's compensation programs to better manage drug safety and costs, according to a report in Business Insurance.

Although this strategy offers a number of challenges -- such as the disconnect between federal and state laws -- the savings can be worth the work because pharmacy benefit management integration can offer a comprehensive view of a workforce's prescription drug use, Rich Leonardo of Express Scripts told the magazine. This information leads to better management of the benefit, especially on the workers' comp side, Leonardo said.

The idea of a wellness program seems clear-cut on the surface: Improve your employees' health and lifestyles, and they'll spend less on health care. That can translate into savings for employers on benefits.

Simple, right? Unfortunately for employers, setting up a wellness program is anything but a simple endeavor. A number of federal laws dictate how a program must be managed, and agencies review and revise the laws frequently.

Take the latest compliance hurdle for wellness programs: A regional office within the Equal Employment Opportunity Commission (EEOC) has ruled that incentives offered to employees' spouses to complete a health risk assessment are a violation of the Genetic Information and Nondiscrimination Act (GINA). No one, however, seems to be able to get details about this decision, according to a report by Human Resource Executive Online.

GINA bars discrimination based on a program participant's information -- a broad definition that includes the medical history of employees and of their spouses, experts say. GINA allows incentives for wellness programs only if participants are not required to supply family medical information to get them. The EEOC decision means spouses can't be required to supply such information when enrolling in a wellness program.

Summer Conley, an attorney with Drinker Biddle & Reath, noted in HREO that the decision "doesn't necessarily jibe with the purpose of [the law] because there's not really genetic information involved when you're talking about your spouse." 

The final outcome of this decision, however, remains murky. EEOC's national office has yet to make a formal announcement. Still, experts suggest employers play it safe and take out any incentive-based requests for family medical history information through a health risk assessment for both workers and their spouses.

GINA is just the tip of the iceberg for employers who want to sponsor a wellness program. According to Amy Gallagher, vice president of major accounts with Cornerstone Group in West Warwick, R.I., HIPAA has the greatest impact on wellness programs because it is broad and covers issues related to health, privacy and benefits. Although HIPAA prohibits employers from discriminating against workers based on their health, companies have some wiggle room, Gallagher noted in an article on GoLocal.com.

For example, while employers generally are barred from charging different rates for workers based on their health, they can award premium discounts for workers who exhibit healthy behaviors or participate in wellness programs.

Ultimately, how HIPAA impacts an employer's wellness initiative depends on the type of plan, Gallagher wrote. Participation-based programs can reward workers for simply participating in a wellness initiative. Standards-based programs, however, grant incentives based on workers achieving a specific goal, such as weight loss or quitting smoking. The standards-based program is subject to much more regulation under HIPAA, according to Gallagher.

"Your prescription for success? Proceed with caution when developing wellness programs," Gallagher writes. "And be sure to seek advice from benefit advisors or wellness consultants experienced in designing and executing successful -- and compliant -- plans."