News Archive

"OBBBA ... introduced several changes affecting HSAs, including a permanent safe harbor for pre-deductible telehealth and remote care, the designation of [ACA] Exchange bronze and catastrophic plans as HSA-compatible, and clarification that qualifying Direct Primary Care Service Arrangements (DPCSAs) do not disqualify individuals from HSA eligibility."  MORE >>

"By breaking down silos between medical and disability data, absence management leaders can uncover actionable insights that improve employee outcomes and reduce organizational risk. This analysis sets out to: [1] Quantify how chronic and complex conditions influence both medical spend and absence patterns. [2] -- Identify which conditions have the greatest impact on cost and workforce availability. [3] Translate these findings into practical strategies for absence programs."  MORE >>

"[1] Prioritize primary care as a strategic investment ... [2] Expand the primary care team ... [3] Improve access through navigation ... [4] Encourage preventive care with the right Incentives ... [5] Choose the right partners to deliver value ... [6] Primary care as the great navigator."  MORE >>

"In 2026, states will receive first-year awards from CMS averaging $200 million within a range of $147 million to $281 million. This unprecedented federal investment will help states expand access to care in rural communities, strengthen the rural health workforce, modernize rural facilities and technology, and support innovative models that bring high-quality, dependable care closer to home."  MORE >>

"[T]he new guidance [1] clarifies that the safe harbor does not extend to in-person services, medical equipment, or drugs furnished in connection with telehealth or other remote care services.... [2] clarifies how Direct Primary Care Service Arrangements (DPCSAs) interact with HSAs.... [3] provides that beginning January 1, 2026, bronze and catastrophic health plans, including those obtained through a health insurance exchange, will be treated as HSA-compatible, even if they don't meet the traditional high-deductible requirements."  MORE >>

"Effective for the 2025 plan year, OBBBA reinstated and made permanent COVID-19-era telehealth relief allowing HSA-compatible high-deductible health plans (HDHPs) to cover telehealth and other remote care services before the statutory minimum deductible is satisfied. Beginning Jan. 1, 2026, OBBBA also allows individuals enrolled in certain direct primary care service arrangements to remain eligible to make or receive HSA contributions and treats certain bronze and catastrophic plans as HDHPs. This article summarizes provisions of Notice 2026-5 most relevant to employers."  MORE >>

"[T]wo areas [for PBMs to] focus on in the coming months ... [1] Operate with full clarity on money flow and decision-making (i.e., clearly defined administrative fees) while making the whole process accessible and visible to your clients.... [2] [C]harge a clear administrative fee and return every rebate and discount to the client. This can help your PBM regain trust and relieve some of the strain that could lead clients to seek alternate options."  MORE >>

"Your at-risk population may be larger than you think, which makes weight-management strategies increasingly important.... Self-funded organizations have more strategic flexibility, but financial modeling is essential before making coverage decisions.  ... Evaluate coverage decisions through a workforce stability lens, not just a cost lens. "  MORE >>

"ERIC has long advocated that Congress enact strong PBM transparency and accountability reforms to provide relief for employers and workers nationwide. In addition to applying fiduciary standards to PBMs, ERIC has called for PBM reforms to foster greater accountability and affordability by: [1] Providing comprehensive PBM transparency. [2] Banning so-called “spread pricing.” [3] Requiring 100% pass-through of rebates and payments from drug manufacturers."  MORE >>

"The guidance addresses telehealth services, direct primary care arrangements and individual market coverage. [Notice 2026-5] does not break much new ground, but a few provisions are worth noting. [1] Telehealth safe harbor made permanent ... [2] Direct primary care service arrangements ... [3] Bronze and catastrophic plans."  MORE >>

"Employers can reduce hidden healthcare costs by using claims and pharmacy data to identify wasteful spend, steering members to high-value providers, tightening pharmacy benefit design, and investing in population health, care navigation, and social determinants of health strategies that improve outcomes and reduce avoidable utilization. [This article unpacks] what is driving costs, where waste hides in your plan, and the practical steps employers can take now to break the cycle."  MORE >>

"The current focus on ghost networks provides a timely catalyst for health plans to strengthen their provider data management processes. A good first step is defining what accuracy and completeness mean for your organization. Set measurable standards; for example, determine how often data must be updated and what percentage of records must be verified at each cycle."  MORE >>

"Over the past few years, employers have navigated one of the most rapid evolutions in workforce expectations in modern history. Hybrid work cemented itself as the norm; employee values shifted dramatically, and organizations restructured benefits and compensation in an attempt to keep pace.... The world of work is no longer just about flexibility or engagement. It is about affordability, access, intelligence, and trust, and employers must adapt quickly to remain competitive in the labor market."  MORE >>

"[K]ey considerations and action items plan sponsors should address prior to the end of this year or at least prioritize in early 2026: [1] Telehealth coverage -- to charge or not to charge ... [2] Dependent care contribution limits -- should you increase the limit? ... [3] Direct Primary Care Arrangements -- some arrangements can be paired with an HSA.... [4] Remember gag clause attestations.... [5] Revisit last year's ACA reporting 'present'.... [6] Update HIPAA Notice of Privacy Practices.... [7] Mental Health Parity & Addiction Equity Act (MHPAEA) NQTL compliance still required.... [8] Routine year-end housekeeping."  MORE >>

"The guidance that enrolling in a [Direct Primary Care Arrangement (DPCA)] will not cause individuals to lose HSA eligibility is helpful. However, questions remain regarding how DPCA offerings can be structured so that their services can be reimbursed from an HSA, and what services may be treated as primary care services. In addition, [Notice 2026-5] provides some flexibility with respect to individuals enrolling in bronze and catastrophic plans off-Exchange or through an ICHRA."  MORE >>

"[HHS has] published a proposed rule ... that would carve out account-based group health plans from the requirement to provide a Medicare Part D-creditable coverage notice to Part D-eligible individuals. This exclusion would be welcome relief for account-based plan service providers and plan sponsors who offer an individual coverage health reimbursement arrangement (ICHRA) or another type of account-based group health plan, such as a health care flexible spending account (FSA), health savings account (HSA), or traditional health reimbursement arrangement (HRA)."  MORE >>

"Enacted into law in July of this year, the OBBBA brought us several new consumer-directed provisions ... The courts, including the Supreme Court, had a busy year as well.... The [ACA] made an appearance in 2025, notably in a major court case.... This year also saw the introduction of an alternative furnishing option for Forms 1095.... A flurry of fiduciary lawsuits this year shone a spotlight on the fiduciary responsibilities employers have as sponsors of group health plans.... [PBMs] also made their way onto this year's compliance-oriented center stage."  MORE >>

"Many federal laws create mandates that may apply to your group health plan. Here are some to be aware of: [1] [ACA] ... [2] [MHPAEA] ... [3] Women's Health and Cancer Rights Act (WHCRA) ... [4] Newborns' and Mothers' Health Protection Act (NMHPA) ... [5] [FMLA].... [6] [USERRA] ... [7] Medicare Secondary Payer (MSP) ... [8] Medicare Prescription Drug, Improvement, and Modernization Act (MMA) ... [9] Federal laws prohibiting employment discrimination."  MORE >>

"Under the bill [HR 6703] ... lawmakers would lean on association health plans ... and individual coverage health reimbursement arrangements, or ICHRA, to offer additional options for enrollees....The bill also seeks to broaden access to stop-loss coverage to mid-size and small employers ... [Th]he legislation aims to address premiums by allocating for cost-sharing reduction payments beginning in 2027.... The bill also includes provisions to increase the transparency around pharmacy benefits[.]"  MORE >>

"[E]mployers favor utilization tactics over structural PBM reforms despite rising specialty drug spend.... Unsustainable specialty medication costs could erode benefits budgets and employee affordability.... 69% include pharmacy in medical plans; only 16% use pass-through PBMs."  MORE >>

"[S]everal new laws will have significant implications for qualified retirement plans, including amendments that must be made by the 2026 plan year.... The recently enacted One Big Beautiful Bill Act (OBBBA) also contains provisions impacting health and welfare plans, many of which are effective beginning January 1, 2026.... [M]any cost-of-living adjustments that are mandated by law will impact retirement plans and health and welfare plans in 2026.... [This article provides] plan sponsors with summaries of the key action items they should be considering, now and in the future[.]"  MORE >>

"Doctors and groups representing employers said they're increasingly hearing about companies cutting weight loss drugs out of health plans next year as costs mount.... Some [employers] are starting to wonder whether they're paying more for obesity drugs than the cash prices being offered, which range from $200 to $450 a month depending on the dose ... That's leading companies to think it makes more sense for workers to get the drugs on their own[.]"  MORE >>

"[1] Health legislation in congress ... [2] Transparency regulations ... [3] OBBB act guidance ... [4] NSA guidance ... [5] Mental Health Parity and Addiction Equity Act (MHPAEA) ... [6] Expansion of fertility benefits ... [7] Direct-to-consumer prescription drug programs ... [8] ERISA preemption of state PBM laws ... [9] Fiduciary breach litigation ... 10. HIPAA wellness/tobacco surcharge litigation."  MORE >>

"Previously, enrollment in a direct primary care service arrangement typically disqualified individuals from HSA contributions.... Now, qualifying direct primary care service arrangements (DPCSAs) are no longer treated as health plans for HSA eligibility purposes. This means you can be enrolled in both a high deductible health plan (HDHP) and a qualifying DPCSA while maintaining your ability to contribute to an HSA."  MORE >>

24 pages. "[T]his report outlines five key recommendations for employers designing sustainable GLP-1 coverage: [1] Establish clear, clinically driven eligibility pathways for GLP-1 coverage. [2] Require participation in behavior, nutrition, or lifestyle change programs as a condition of coverage. [3] Provide structured support for employees who choose to taper or discontinue GLP-1 therapy. [4] Review existing vendor capabilities before adding additional point solutions. [5] Contract with vendors to drive outcomes while examining overall program costs."  MORE >>