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CRS Legal Sidebar: Litigation over State Attempts to Lower Drug Costs: Prescription Drug Affordability Boards (PDABs)

"[S]everal states have also taken actions meant to lower drug costs, enacting various measures including price transparency laws, anti-gouging statutes, outcomes-based contracts, state drug wholesale importation programs, and prescription drug affordability boards (PDABs). Many of these state measures, including PDABs, face significant and ongoing legal challenges from drug manufacturers." [LSB11390 Jan. 27, 2026]

ERISA vs. Non-ERISA Benefits: Key Legal Differences Explained

"What plans does ERISA cover (and exclude)? ... Key legal differences in ERISA vs. Non-ERISA plans ... Special considerations applied to different types of benefits (health, disability, and retirement) ... Determining ERISA plan status: how to know if ERISA applies ... Recent legal developments and impact ... When to seek legal guidance for an ERISA or non-ERISA claim."

Legal Issues in Value-Based Care Contracts for Self-Insured Employers

"Implementing a value-based contract that ties payments to quality metrics or population health outcomes creates several fiduciary questions. Does shifting risk to a provider expose plan participants to narrower networks or limited access that may conflict with fiduciary obligations? How should fiduciaries evaluate whether the incentive structures truly benefit plan participants rather than merely reduce employer costs? ... Using standardized CMS data sets minimizes ambiguity and improves objective benchmarking. From a legal point of view, incorporating CMS data sets requires careful implementation. "

Solicitor General Supports Plan Sponsors on Key ERISA Legal Questions in Supreme Court Amicus Briefs

"In both cases, the Solicitor General agreed with the petitioners ... that the legal questions are sufficiently important to warrant the Supreme Court's review. Further, the Solicitor General supported the plan sponsor and fiduciary defendants (and disagreed with the plaintiffs) on the merits of the legal questions being presented to the Supreme Court. This reflects a clear shift under the new Administration to interpret ERISA in reasonable and common-sense manner."  [Johnson v. Parker-Hannifin Corp., No. 24-3014 (6th Cir. Nov. 20, 2024; cert. pet filed Mar. 26, 2025, No. 24-1030; DOL amicus brief filed Dec. 9, 2025); Pizarro v. Home Depot, No. 22-13643 (11th Cir. Aug. 2, 2024; cert. pet. filed Dec. 3, 2024; DOL amicus brief filed Dec. 9, 2025) ]

Pharmacy Groups Defend Iowa PBM Law Amid Legal Challenge

"The National Community Pharmacists Association, Iowa Pharmacy Association, American Pharmacists Association and Independent Pharmacy Cooperative filed a friend-of-the-court brief ... arguing that the law is legal and urging the 8th Circuit Court of Appeals to allow it to stand. The groups, which represent independent community pharmacies, say that PBM actions targeted by Iowa's law are driving unaffiliated pharmacies out of business and harming patient access to drugs." [Iowa Assoc. of Bus. and Ind. v. Ommen, No. 25-0211 (S.D. Iowa Jul. 21, 2025; on appeal to 8th Cir. No. 25-2494)]

DOL Has Stepped Into Morgan Stanley's Legal Battle

"For wealth advisors and RIAs, the implications of this ongoing dispute extend beyond the legal maneuvers. Deferred compensation remains a powerful retention tool across the wirehouse and brokerage landscape ... If courts or regulators were to determine that such programs fall under ERISA, it could significantly alter how firms structure advisor pay, adding compliance burdens and limiting forfeiture provisions that firms rely on to retain talent." [DOL Advisory Opinion 2025-03A; O'Neill v. Morgan Stanley, No. 24-00358 (FINRA Aug. 8, 2025)]

Citing Legal Challenges, DOL to Overturn Biden-Era Independent Contractor Rule

"Citing to five separate legal challenges to the [2024 Rule] and its intention to 'reduce unnecessary burdens on employers and employees,' the Trump DOL aims to retool its independent contractor rule. This announcement ... comes on [the] heels of the Trump DOL announcing on May 1, 2025 that it would no longer enforce the 2024 IC Rule."

CMS's Hospital Price Transparency Final Rule and Related Legal Challenge

"Like the drug price disclosure rule, this hospital price transparency rule has sparked debate and drawn a legal challenge by entities ... affected by the rule.... [This article] provides an overview of the CMS hospital price transparency final rule, the bases of the legal challenge against it, and how the legal challenge may be relevant to other legislative healthcare price transparency proposals that Members of Congress may continue to consider." [CRS LSB10392]

2012 ESOP Legal Update

This issue brief, written by a group of well-known practitioners, summarizes judicial and regulatory developments in 2011 affecting ESOPs and 401(k) plans that invest in employer stock. Cases analyzed include the Supreme Court's decision in CIGNA v. Amara, a number of stock drop cases, several fiduciary breach claims, and other ESOP-related cases. The section on regulatory developments analyzes IRS guidance affecting ESOPs and addresses the Department of Labor's proposed regulation expanding the definition of a "fiduciary" under ERISA.

Chart: Employer Costs for Legally Required Benefits in December 2011

"The average cost for legally required benefits was $2.33 per hour worked in private industry (8.1 percent of total compensation) in December 2011. Social Security comprises the largest legally required benefit cost component at $1.34 per hour or 4.7 percent of total compensation. Legally required benefits such as Social Security and Medicare are often directly linked to wages; therefore, higher paid occupations or industries will typically show higher cost estimates for this compensation component."

How to Design a Retirement Education Program That Reduces Your Company's Legal Liability

Excerpt: [The author outlines a program you can put into place that she feels] is sufficiently protective given the current legal environment. This does not guarantee you will never face a legal issue, but it offers a high degree of protection should you face legal challenges surrounding the information you provided employees to help them make investment decisions.

Georgetown University Project Analyzes Legal Issues Relating to Health Reform

Excerpt: Supported by the Robert Wood Johnson Foundation, the O'Neill Institute for National and Global Health Law at Georgetown University has published a number of issue briefs that analyze legal issues relating to health reform, and outline potential solutions to some of the most significant legal problems in the health reform debate. The Institute's Legal Solutions in Health Reform project covers topics ranging from the constitutionality of a federal insurance mandate and the role of health insurance exchanges to privacy issues associated with health information technology and the purchase of insurance across state lines. [The project can be accessed at http://www.law.georgetown.edu/oneillinstitute/projects/reform/index.html.]

Telecommuting: Ten Legal Considerations

Excerpt: Before permitting employees to telecommute, employers should consider the ten legal issues outlined [in the target page]. Employers are also well-advised to develop a written telecommuter agreement advising telecommuting employees of their responsibilities and requiring them to commit to certain performance band behavioral expectations.

Opinions Mixed on Future of Cash Balance Plans: Rep. Boehner's Bill Would Make the Plans Legal

Excerpt: After two years, there may be an end in sight to the legal limbo. In June, Rep. John Boehner, R-Ohio, proposed the Pension Protection Act, which, if passed, would make cash-balance pension plans legal. Employers have been waiting for such guidance on the issue, but some like Voith say that even if the courts or the federal government decide the plans are legal, companies will not be rushing back into them.

Report Identifies Legal Barriers to the Use of Patient Information to Improve Health Care Quality (PDF)

67 pages. Excerpt: This Policy Brief, Charting the Legal Environment of Health Information, is part of a project ... designed to assess the legal environment for health information systems. .... The first phase ... offers a broad exploration of the legal environment of health information systems, examining many longstanding issues as well as recent matters that have arisen as a result of the new information technology that enables these systems to share health information among many users.

Yale Law Professor Discusses Potential Legal Issues Arising from Same-Sex Marriage

Excerpt: The news that gay and lesbian couples will be able to apply for marriage licenses and legally marry in Massachusetts starting in May raises important and largely unresolved legal questions about the rights of states to formulate their own family law policies versus their conflicting obligations to recognize legal relationships entered into in other states.

DOL Files Amicus Brief Clarifying Legal Framework for Pension Risk Transfers

"Filed as part of an ongoing effort to stop regulation by litigation, the brief ... reiterates the appropriate standards for derisking transactions known as pension risk transfers.... In the brief, the department said fiduciaries enjoy deference a long as they engage in the pension risk transfer process in a way that demonstrates prudence and loyalty." [Konya v. Lockheed Martin Corp., No. 24-0750 (D. Md. Mar. 28, 2025; on appeal to 4th Cir. No. 25-2061)]

Employers' Legal Minefield: Balancing COBRA, the ACA, ERISA, and Immigration Enforcement

"This article addresses the tensions employers face when an employee loses valid work authorization or is discovered to have used false identity documents.... [A] termination of employment with a loss of health plan coverage usually triggers a legal obligation to offer continuation coverage. This can leave employers questioning whether offering COBRA to someone now unlawfully present could violate immigration law.... Employees who lose TPS or other temporary work authorization present a particular challenge."

North Carolina State Health Plan Considers Legal Action Against CVS Caremark

"The health plan that covers some 750,000 current and former state employees and their families has hit a stone wall in negotiations with its pharmacy benefit manager, CVS Caremark, and is pondering legal action against the company ...  The company owes the state tens of millions of dollars and is trying to rewrite their contract to get out of having to pay it back, State Treasurer Brad Briner claimed[.]"

CRS Legal Sidebar: Most-Favored-Nation Prescription Drug Pricing Executive Order

"[T]he 2025 EO resembles a 2020 MFN drug pricing executive order ... which also directed the HHS Secretary to implement MFN pricing, but which was limited in application to Medicare Part B. This Legal Sidebar ... analyzes selected legal issues related to the HHS Secretary's authority to implement MFN pricing as directed in the 2025 EO.... [It] also explores the HHS Secretary's authority to impose MFN pricing for drugs in federal health care programs ... as well as in private markets. The Sidebar concludes with an analysis of how the MFN prices might interact with other existing federal programs[.]" [LSB11319, Jun. 5, 2025]