"In late January, [EBSA] released a proposed rule ... which focused on methods of improving transparency around the fees and compensation that Pharmacy Benefit Managers (PBMs) receive. One week later ... the President signed the Consolidated Appropriations Act of 2026 (CAA 26) into law. This law puts the proverbial target on the backs of PBMs by requiring not only more transparency, but also new reporting on PBM rebates, price spreading, and compliance. The combination of these new regulatory developments has the potential to alter the role and work of PBMs and how they interact with employer-sponsored group health plans." MORE >>
"While the FTC's lawsuit originally focused on insulin pricing practices, the settlement goes further, requiring structural changes to how Express Scripts prices drugs, manages rebates, works with pharmacies, and reports information to plan sponsors.... For employers, the agreement may signal a broader shift in the industry toward true net-cost drug pricing models, with potential implications for pharmacy benefit design, budgeting, and future PBM contracting." MORE >>
"David Marin, CEO of the PCMA, said ... that given the requirements signed into law in the funding deal, PBMs will soon be required to provide significant amounts of data to employers, unions and government agencies.... As these organizations adapt to the requirements including in the funding package, the [DOL] should roll back the proposed rule rather than 'forcing PBMs to comply with a Rube Goldberg regulatory machine,' Marin said." MORE >>
"While AI can enable PBMs to operate more efficiently and optimize pricing to help lower drug costs, this new technology raises several data privacy, regulatory, and contractual risks for employers that sponsor health plans. This Insight explains how plan sponsors can spot potential red flags and avoid potential liability while benefiting from the advantages that AI can bring to healthcare costs and administration." MORE >>
"Early 2026 brought two major federal actions that reshape how pharmacy benefit managers (PBMs) are regulated and how plan fiduciaries oversee prescription drug benefits. ... Together these changes send a clear message that PBM arrangements are no longer something plan sponsors can treat as too technical or complicated to understand. Fiduciaries are expected not only to obtain PBM data but to evaluate it, document decisions, and monitor PBM performance over time." 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 >>
"Like the other three district courts, the Southern District of New York ... ruled that the plaintiffs' claim of harm in the form of higher premiums was too speculative to confer standing.... However, it was the plaintiffs' alleged harm in the form of higher cost-sharing requirements -- i.e., copays, coinsurance, and deductibles -- where the district court distinguished this case from the others. Unlike other cases, the district court here noted the plaintiffs' allegations of higher cost-sharing were based on 'specific overpayments, made on specific dates, at specific markups.' " [Stern v. JPMorgan Chase & Co., No. 25-2097 (S.D.N.Y. Mar. 9, 2026)] MORE >>
"Corporate wellness perks are on the chopping block. Spending on them dropped 19% per employee between 2023 and 2025, from $1,366 to $1,103 ... A 2025 Wellhub survey found that only about 29% of employees were satisfied with wellness programs, down from 41% in 2024, suggesting that many perks are underused or hard to access. Similarly, a 2023 Deloitte study showed that nearly 70% of workers didn't use the full value of their company's well-being resources, because they were too confusing or time-consuming." MORE >>
"The U.S. health insurance market has consolidated substantially, and each of the three large [PBMs] -- that together control 75% of the market -- is integrated with a large medical insurer. Recent government actions reflect concerns with how these big PBMs conduct their business and closer scrutiny of their parent companies. Here's an overview of these recent government and legislative actions and the potential implications for drug pricing and plan sponsors." MORE >>
"What's clear from the data is that organizations aren't approaching GLP‑1s casually. They're asking: What's sustainable? What's fair? What's realistic for a company of our size? This article breaks down what employers need to know -- and how the 2026 insights can guide your decision‑making." MORE >>
"[T]he court dismissed the breach of fiduciary duty claims finding that Plaintiffs' allegations focused on purported plan design issues, which are a settlor function -- not a fiduciary function; however, the court allowed the prohibited transaction claims alleged by the Plaintiffs to survive, and the action against JPMorgan will proceed." [Stern v. JPMorgan Chase & Co., No. 25-2097 (S.D.N.Y. Mar. 9, 2026)] MORE >>
"Seven percent of adults who currently take prescription medication say they have visited the TrumpRx website to compare prescription drug prices, rising to one in six (16%) of those who currently or have ever taken a GLP-1 medication ... [A] majority of the public (59%) is worried about affording prescription drugs for themselves and their families, the largest share since KFF first polled this question in 2018.... About four in 10 (43%) U.S. adults say they have not taken their medication as prescribed in the past year due to costs." MORE >>
"Lilly will offer Zepbound, an injectable GLP-1 medication, at a price of $449 per month for all doses ... That's the same price for higher doses of Zepbound available to patients without insurance coverage through the direct-to-consumer market, including on TrumpRx. The model is one of several that allow employers to bypass pharmacy benefit managers (PBMs) ... Novo Nordisk, which manufactures Wegovy, announced a similar program in December." MORE >>
"For over 50 years, [ERISA] has served as the foundation around which employer benefit plans are built. That foundation, however, has shown cracks in recent years as the cost of healthcare continues to rise and many states try to take regulatory matters into their own hands. From Alabama to California, state houses have passed legislation intent on keeping pharmaceutical costs in check. Many of these laws are being challenged in the courts. How those cases play out could mean change and greater complexity in the ways that employers manage health and welfare benefits." MORE >>
"JPMorgan violated ERISA by using a 'fundamentally flawed' process to hire CVS Caremark, whose parent company CVS Health is an investment banking client, the proposed class action lawsuit claims.... JPMorgan allowed CVS Caremark to mark up prices for 366 generic drugs by an average of 211%, causing some employees to pay more than uninsured patients, the complaint alleges." [Stern v. JPMorgan Chase & Co., No. 25-2097 (S.D.N.Y. Mar. 9, 2026)] 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 >>
"The FTC's original theory -- focused on PBM rebate-driven incentives and formulary design affecting insulin access and patient out-of-pocket costs -- has now produced a detailed, enforceable template in the Express Scripts consent order. If OptumRx and Caremark reach comparable settlements, the practical outcome could be an industry-wide shift in what regulators (and plaintiffs) treat as the 'baseline' PBM model." MORE >>
"The order followed a market conduct examination that identified multiple violations of West Virginia laws governing PBMs. The enforcement action reflects increasing regulatory scrutiny of PBMs by state authorities. Several states ... have heightened scrutiny regarding reimbursement practices, rebate administration and relationships with pharmacies and health plans." 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 proposed class action on behalf of tens of thousands of employees accused JPMorgan of violating [ERISA] by using a 'fundamentally flawed' process to hire CVS Caremark, whose parent CVS Health is an investment banking client." [Stern v. JPMorgan Chase & Co., No. 25-2097 (S.D.N.Y. Mar. 9, 2026)] MORE >>
"Lawmakers continue to advance a wide range of approaches designed to enhance prescription drug access and affordability for both states and consumers. Even as the legislative landscape evolves, initiatives including PBM and 340B reform are likely to be enacted this year. " MORE >>
"Between 2011-2019, for the nationally representative beneficiary, the share of drugs excluded from formularies increased from 7.5% to 13.4%, the share of drugs subject to administrative restrictions such as prior authorization or step therapy increased from 18.1% to 43.7%, and the share of drugs on non-preferred tiers decreased from 57.8% to 42.2%. The share of drugs with any coverage restriction increased from 69.7 to 79.0%. Health plans and drugs subject to federal coverage mandates saw much larger increases in prior authorization and increases in non-preferred status." MORE >>
"Building on the momentum from 2025, Q4 brought pivotal developments in GLP-1 therapies, continued PBM scrutiny, biosimilar expansions and persistent issues with pharmacy access. These shifts underscore the need for employers and consultants to prioritize agility, transparency and member-centric strategies." MORE >>
"PBMs must now adhere to the same compensation disclosure rules applicable to other ERISA plan service providers and advisors, such as investment advisors, recordkeepers or brokers, and other entities receiving 'indirect compensation' (e.g., accounting, auditing, actuarial, banking, and consulting service providers), which, in turn, will enable employers sponsoring group health plans to better evaluate and negotiate PBM compensation under their contracts." MORE >>
