News Archive

"[T]he government funding bill that was signed into law on February 3, 2026 ... contains three reforms that apply to Medicare Part D and two that apply to commercial PBMs.... DOL issued a proposed rule on January 29, 2026, to require commercial PBMs to report on several transparency measures to plan fiduciaries of self-insured group health plans subject to [ERISA]."  MORE >>

"HR 7362, the Form 5500 Filing Simplification Act ... would extend the deadline for filing the form by almost three months.... This effectively would mean that the deadline for calendar-year plans to file the Form 5500 would be Oct. 15, not the current July 31."  MORE >>

"The Consolidated Appropriations Act, 2026 (CAA) (HR 7148) ... added sweeping reporting mandates to ERISA related to the provision of pharmacy benefit management services for ERISA-covered group health plans.... The mandates regulate contracting by group health plans, health insurance issuers offering group health insurance coverage, entities providing pharmacy benefit management services on behalf of a plan or issuer, and 'applicable entities.' "  MORE >>

"With the skyrocketing costs of health care and increased pharmacy spending, the implementation of new PBM reforms was expected. No immediate action is required, but employers should be prepared for restructuring of PBM contracts, reporting and oversight governance. Many of the CAA 2026 reforms are incorporated into ERISA, the Public Health Service Act, and the Internal Revenue Code, and will impact all employer plan sponsors, not just ERISA plan fiduciaries."  MORE >>

"The Federal Departments released proposed Transparency in Coverage (TiC) regulations to improve the public disclosure of prices for medical items and services. [This article describes] [1] The issues that make pricing data challenging to download, understand or consume. [2] Four new files to provide additional pricing context: Change Log, Utilization, Taxonomy and Text. [3] Changes to the INN Rate and OON Allowed Amount Files, which are intended to reduce the size of the Files and increase the amount of usable pricing data."  MORE >>

"[T]he proposed regulation is much broader than the corresponding rule for pension and retirement plans, not only in terms of the type of compensation and fees that are subject to disclosure but also regarding [1] the extent of the written disclosure, [2] the timing and frequency of disclosure, [3] the requirement to generally disclose using monetary amounts (versus formulas or percentages), and [4] the provision of specific rights to plan fiduciaries with respect to the disclosures (e.g., audit rights)."  MORE >>

"The required advance, written disclosures would be necessary for parties to contracts or arrangements for PBM services to obtain the benefit of a prohibited transaction exemption under ERISA 408(b)(2).... If a third-party administrator (TPA) contracts with an ERISA self-insured group health plan to provide pharmacy benefit management services, the TPA is a covered service provider under this proposal, even if it intends to rely on another provider to perform those services (e.g., a subcontracted PBM)."  MORE >>

"[I]ndividuals and businesses in the State of Montana affected by severe storms and flooding that began on Dec. 10, 2025 ... now have until May 1, 2026, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in the Blackfeet Indian Reservation, Lincoln, and Sanders counties qualify for tax relief."  MORE >>

"The proposed regulations would only apply to ERISA plans, not governmental or church plans, and for now are limited in scope to self-funded plans, though the DOL has left space in the proposed regulations to expand to fully insured plans in the future.... The rules build upon the statutory framework established by ERISA Section 408(b)(2)(B), which requires group health plan sponsors to request and review fee information from 'covered service providers' to demonstrate the reasonableness of the arrangement under ERISA's prohibited transactions requirements."  MORE >>

"The Proposed Rule attempts to provide ... transparency by: [1] Requiring PBMs to provide written disclosures of the PBM's direct and indirect compensation ... reasonably in advance of entering into or renewing a service arrangement ... [2] Establishing audit provisions designed to ensure that plan fiduciaries can verify the accuracy of the disclosures; and [2] Providing relief for plan fiduciaries if the PBM fails to meet its disclosure obligations.... [T]he Proposed Rule would require PBMs to disclose compensation as a monetary amount (even if estimated), rather than providing formulas, which are notoriously difficult for fiduciaries to assess when evaluating reasonableness."  MORE >>

"The IRS now gives employers 90 days to respond to Letter 226J. Prior to 2025, the IRS only gave 30 days which may likely resulted in employers scrambling to investigate the tax assessments or asking for extensions. The deadline is 90 days from the date on the Letter 226J, not from when you received it."  MORE >>

"In FY 2025, EBSA closed 878 civil investigations. Of those, 556 investigations (63 percent) produced monetary results for plans or other corrective action, for a total of $714.4 million recovered.... In FY 2025, [EBSA] obtained 297 non-monetary civil corrections, including: [1] removing 15 fiduciaries, [2] barring 24 individuals from serving as fiduciaries, [3] appointing 18 fiduciaries, [4] improving missing participant procedures for 49 plans, and [5] implementing 61 global corrections across multiple ERISA-covered health plans."  MORE >>

"While ChatGPT can tell you that you need an MRI for your knee pain, it can't tell you that the imaging center five miles north charges $150 while the one downtown wants $1,800 for the exact same scan. ... ChatGPT Health can coach employees on diet, track workouts and explain medical terms. That's genuinely valuable for healthfulness and engagement. But when employees still don't understand their benefits coverage or how to find affordable, in-network care, we're only solving part of the equation."  MORE >>

"The premium adjustment percentage for the 2027 benefit year is 1.8916224814 ($8,919/$4,715), which represents an increase in PHI premiums of approximately 89.2 percent over the period from 2013 to 2026....

'[T]he 2027 maximum annual limitation on cost sharing is $12,000 for self-only coverage and $24,000 for other than self-only coverage. This represents an approximately 13.2 percent increase from the 2026 parameters of $10,600 for self-only coverage and $21,200 for other than self-only coverage....

'[T]he 2027 required contribution percentage under section 5000A of the Code [is] ... 8.50 percent ... an increase of approximately 0.45 percentage points from the 2026 value."  MORE >>

"Covered service providers would be required to provide initial disclosures to the plan fiduciary reasonably in advance of entering into, renewing, or extending a contract or arrangement. The initial disclosures would include a description of the pharmacy benefit management services as well as information on the direct compensation from the self-insured group health plan and compensation reasonably expected to be received from other arrangements ... The proposed rule would also require covered service providers to provide semiannual disclosures of the same compensation categories based on amounts actually received."  MORE >>

"HHS has announced adjustments to civil monetary penalties for statutes within its jurisdiction. The latest amounts are based on a cost-of-living increase of 1.02598%. These adjustments are effective for penalties assessed on or after January 28, 2026, for violations occurring on or after November 2, 2015."  MORE >>

"For self-insured employers, rising medical claim denials are no longer a back-office nuisance, they represent a direct fiduciary risk under [ERISA].... This article reframes claim denials through the plan sponsor lens ... [exploring] the drivers behind rising denials, the financial and legal implications, recent court cases, and practical steps to strengthen governance and protect both plan integrity and member trust."  MORE >>

"The default approaches are either to immediately move the continuing employees to the buyer's health plan or to continue coverage under the seller's health plan for a transitional period. However, in some situations (particularly where the buyer does not acquire the seller's health plan) the parties will consider a variety of health coverage alternatives for the continuing employees. Each of these alternatives comes with multiple potentially significant issues[.]"  MORE >>

212 pages. "The Department is proposing a regulation that would require providers of pharmacy benefit management services and affiliated providers of brokerage and consulting services to disclose information about their compensation to fiduciaries of self- insured group health plans subject to [ERISA].... These disclosure requirements would apply for purposes of ERISA's statutory prohibited transaction exemption for services arrangements. This proposal implements section 12 of President Trump's Executive Order 14273, Lowering Drug Prices by Once Again Putting Americans First ...

"The Department's proposed regulation is intended to provide much needed transparency into contracts and arrangements with PBMs and affiliated brokers and consultants so that the responsible plan fiduciaries of ERISA-covered self-insured group health plans can better fulfill their statutorily mandated role to determine that the service contracts or arrangements are reasonable. Under the Department's proposed regulation, these service providers would be required to provide robust disclosures to responsible plan fiduciaries of self-insured group health plans regarding their compensation for such services, including the advance disclosure of compensation they reasonably expect to receive. The proposed regulation also includes audit provisions designed to ensure that the responsible plan fiduciaries of self-insured group health plans can verify the accuracy of the disclosures. The responsible plan fiduciaries would be able to use the disclosures in their process of selecting a provider of pharmacy benefit management services, engaging an affiliated broker or consultant, monitoring these service providers' operations and compliance with contractual obligations, and also in analyzing the drivers of prescription drug costs."  MORE >>

"Issued under ERISA's statutory service provider prohibited transaction exemption, the proposed rule requires PBMs to disclose the following information for the first time: Rebates and other payments from drug manufacturers. Compensation received when the price paid by the plan for a prescription drug exceeds the amount reimbursed to the pharmacy. Payments recouped from pharmacies in connection with prescription drugs dispensed to the plan. The proposed regulation would also allow plan fiduciaries to audit the accuracy of PBM disclosures and provides additional relief for plan fiduciaries if their PBM fails to meet its obligation."  MORE >>

24 pages. "What's New:  [1]  Changes to 'coverage month' definition for PTC/APTC ... [2] Reporting entities no longer required to send minimum essential coverage (MEC) forms automatically."  MORE >>

"[A]mong other requirements, HR 7148 proposes the following new rules and regulations impacting PBM arrangements: [1] PBM rebate pass-through and compensation disclosures for ERISA fully insured and self-funded plans ... [2] PBM reporting obligations for fully insured and self-funded group health plans.. [3] Compensation disclosures and reporting obligations for Medicare Part D prescription drug program."  MORE >>

"Make sure health and welfare plan documentation and delegation is current, accurate, and understood.... Set a proactive annual calendar for welfare plan governance and vendor oversight.... Keep detailed records of welfare plan decisions, especially exceptions, claims escalations, and vendor direction."  MORE >>

"The Paperwork Burden Reduction Act gives employers new flexibility in how they distribute Forms 1095-B and 1095-C. Instead of sending forms to everyone, employers can use an alternative furnishing method, providing the forms only upon request -- as long as IRS requirements are met."  MORE >>

"Comments are invited on: [1] Whether the collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; [2] the accuracy of the agency's estimate of the burden of the collection of information; [3] ways to enhance the quality, utility, and clarity of the information to be collected; [4] ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology; and [5] estimates of capital or start-up costs and costs of operation, maintenance, and purchase of services to provide information.... There is no change to the previously approved information collection."  MORE >>