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"The new legislation aims to level the playing field. By restricting the power of PBMs....[The] Act would: [1] Give patients more choices in where they get their medication, ending the practice of steering customers to PBM-owned pharmacies. [2] Standardize drug payments so that pharmacies are reimbursed fairly, regardless of their size or ownership. [3] Increase transparency in drug pricing[.]"  MORE >>

"Congress created the federal independent dispute resolution process (IDR)to determine payment when providers and insurers cannot agree. In theory, IDR was designed to be a streamlined arbitration process. In practice, it has experienced significant disputes and challenges within the healthcare reimbursement landscape, even though many providers still do not appreciate the legal and financial risks the process can entail."  MORE >>

"The proposal would require all employers in the county to offer at least 18 weeks of paid parental leave, making Allegheny County the first county in Pennsylvania to adopt paid parental leave. The proposal would also amend the county's paid sick leave provision, allowing employees to accrue more sick leave at a faster rate."  MORE >>

"The Tennessee General Assembly recently passed the Freedom, Access and Integrity in Registered Pharmacy Act, known as the FAIR Rx Act (SB 2040/HB 1959). The legislation targets vertical integration in the pharmacy market by prohibiting certain entities from owning or controlling a pharmacy while also owning or controlling a PBM and a health insurance issuer. This is not a minor transparency bill. It is not simply another reporting requirement. It is a structural reform bill."  MORE >>

"The OIG concluded that CVS Caremark overcharged the Carrier and the Federal Employees Health Benefits Program by $615M ... That is a blunt reminder that a contract labeled 'transparent' does not necessarily yield transparent results. It also confirms something plan sponsors in the commercial market should already understand: the real fight is not over labels. It is over definitions, controls, data access and the PBM's ability to decide what counts as its cost and what value must be shared with the plan."  MORE >>

"These comprehensive reforms establish rigorous licensing, transparency and operational standards for all PBMs operating in Ohio, promising substantial benefits for health plans, employers, insurers, pharmacies and consumers alike."  MORE >>

"While prior legislative efforts chipped away at PBM practices through state laws and targeted federal rules, this statute takes a more structured approach by imposing transparency requirements, rebate pass-through obligations, and compensation reforms that directly affect both ERISA plan sponsors and Medicare Part D programs.... [S]takeholders that understand how to use the law will gain a strategic advantage. Those that do not will continue operating under legacy PBM arrangements that no longer reflect the regulatory landscape."  MORE >>

"While federal policymakers continue to debate broader reforms to the pharmaceutical supply chain, state attorneys general and insurance commissioners have begun taking matters into their own hands. Recent enforcement actions involving two of the nation's largest PBMs, CVS Caremark and Express Scripts, illustrate how states are increasingly regulating PBMs and challenging practices that they believe harm independent pharmacies and drive up drug costs."  MORE >>

"The plaintiffs allege that the corporation breached its ERISA fiduciary duties by allowing excessive prescription drug prices within its health plan.... The lawsuit alleges that the corporation's health plan paid more than $6,000 for a 30-tablet supply of the generic multiple sclerosis drug teriflunomide. According to the plaintiffs, the same medication could be obtained at retail pharmacies for a fraction of that price resulting in markup of 38,000%." [Stern v. JPMorgan Chase & Co., No. 25-2097 (S.D.N.Y. Mar. 9, 2026)]  MORE >>

"If enacted, this regulation would ensure that critical data on drug utilization, pricing, rebates and PBM business practices are consistently reported to CHIA to enhance transparency, better-informed policy decisions and a more equitable healthcare system."  MORE >>

"For independent pharmacies, this lawsuit highlights a recurring and frustrating reality: When states attempt meaningful PBM reform, ERISA often becomes the battleground.... [The case] reinforces a key takeaway: lasting and sustainable PBM reform may ultimately require federal action and not just state based regulation." [Pharmaceutical Care Management Association v. Bonta, No. 26-0012 (C.D. Calif. complaint filed Jan. 2, 2026)]  MORE >>

"Within this legislative package, at least two sections stand out as game-changing provisions: [1] Sec. 6223: Assuring pharmacy access and choice for Medicare beneficiaries, and [2] Sec. 6224: Modernizing and ensuring PBM accountability."  MORE >>

"The complaints advance a unified and increasingly familiar theory: once voluntary benefits are offered through an ERISA-governed welfare plan, they are subject to ERISA's full fiduciary framework.... According to the plaintiffs, failures in process, rather than outcomes alone, caused plan participants to pay excessive and unreasonable premiums, while brokers and other service providers reaped outsized financial benefits."  MORE >>

"The House Bill will have an impact that employers should note regarding [1] the administration of compliant health savings account (HSA) benefit programs, [2] changes to the health benefit exchanges under the [ACA] that could impact employer-provided medical insurance benefits, and [3] new restrictions on enforcement of Employee Retention Credit (ERC) claims."  MORE >>

"Already reported in ERISA class action lawsuits alleging fiduciary breaches for failure to safeguard plan assets are cases with allegations of failure to protect confidential personal financial information. Safeguarding the sensitive personal financial data contained in ERISA accounts from cyber threats presents a unique challenge. No federal statute specifically addresses cybersecurity protection of electronic records."  MORE >>

"An employee-initiated termination of employment can be deemed an involuntary termination if the termination is for 'good reason' in response to employer actions resulting in a material negative change in the employment relationship, similar to constructive discharge.... [Notice 2021-31] identifies a number of other termination scenarios that qualify as an involuntary termination for purposes of COBRA premium assistance[.]"  MORE >>

"As a result of amendments made to Section 162(m) of the Internal Revenue Code by the Tax Cuts and Jobs Act (TCJA), certain mandatory delayed payment provisions appearing in many nonqualified deferred compensation plans (NQDC) maintained by publicly traded corporations could create a costly payment trap for employers.... In order to take advantage of this relief, however, affected employers must amend their NQDC Plans by December 31, 2020 to remove the mandatory delayed payment provisions."  MORE >>

"Review and identify all company-sponsored employee benefit plans to determine if the plan conditions benefits, including the payment or vesting thereof, on a determination of disability.... Amend claims procedures and update notices, Summary Plan Description and third-party service provider agreements ... Employees involved in making disability claims determinations should be trained on the new requirements imposed under the Final Regulations."  MORE >>

"Notwithstanding that the right to convert to an individual insurance policy had long since expired, the court crafted a remedy under ERISA that imposed a surcharge on the employer equal to the $750,000 in life insurance that the physician employee would have elected to convert to an individual policy but for the plan administrator's breach of its fiduciary duty; the court also awarded the physician's spouse interest, legal fees and costs associated with bringing the lawsuit. Because the ability to convert to an individual policy was no longer available, the employer, and not the insurance company, is obligated to make all of these payments." [Erwood v. Life Insurance Company of North America and Wellstar Health System, Inc. Group Life Insurance Program, No. 14-1284 (W.D. Penn. Apr. 13, 2017)]  MORE >>

"Employers who have a desire (or perhaps a need) to cut benefit costs should feel somewhat more secure, and possibly inspired, to undertake a legal review of their retiree benefit programs and re-evaluate whether they can amend, modify or terminate those programs. In the more recent past, it has been a best practice for employers to reserve an express contract right to amend, modify or terminate retiree benefits at any time and for any reason. Employers that have done so should have a clear path when altering retiree benefits." [M&G Polymers USA, LLC v. Tackett, No. 13-1010 (U.S. Jan. 26, 2015)]  MORE >>