"Plaintiff alleged that Caremark unjustly enriched itself by covering plan members' maintenance prescriptions only if filled at CVS retail pharmacies or through mail order, in violation of two Arkansas statutes ... Because PBMs manage benefits on behalf of plans, the court reasoned, regulation of PBMs functions as regulation of the plan itself.... The court concluded that these requirements interfere with the nationally uniform plan administration that ERISA was enacted to protect, and that ERISA therefore preempts them, rendering them without effect. Because Plaintiff's unjust enrichment theory depended on violations of preempted requirements, it did not state a plausible claim, and the court affirmed." [Flowers v. Caremark PCS Health, LLC, No. 25-3068 (8th Cir. June 29, 2026)] MORE >>
"ERISA cannot easily substitute for a coherent health care cost-containment strategy. It was not written to regulate provider markets, set prices, restructure incentives, or redesign the health care delivery system. Policymakers and advocates should therefore be careful not to ask ERISA to carry more than it can bear. The better course is to strengthen ERISA where it naturally applies -- transparency, fiduciary process, disclosure, and plan governance -- while addressing the underlying drivers of health care costs through other statutes and policies designed for that purpose." MORE >>
"President Trump on [June 29] announced in a social media post that he will nominate Keith Sonderling to be the next Secretary of Labor. Sonderling has been serving as Acting Labor Secretary since April, after then-Labor Secretary Lori Chavez-DeRemer resigned following allegations of misconduct and other improprieties." MORE >>
"Whether the Florida CVS Caremark investigation ultimately results in litigation, a settlement, policy changes or no enforcement action at all, one thing is already clear: state regulators are becoming increasingly willing to use their existing enforcement authority ... Florida does not appear to be focused on a single disputed claim, a single pharmacy contract or a single reimbursement issue. Instead, the state appears to be examining how PBM vertical integration may affect competition across the pharmacy marketplace." MORE >>
"Senate Bill 1545 ... would prohibit PBMs from owning or holding permits for the retail sale of prescription drugs in Arizona beginning January 1, 2027. While the bill remains in the early stages of the legislative process, it has already attracted attention because it goes beyond traditional PBM reform measures and directly targets vertical integration and follows a growing trend of similar bills." MORE >>
"In their opposition, Defendants argue that the eight challenged provisions of the 2027 NBPP final rule are authorized by the statute and are justified by current data and market conditions to address significant market failures. In addition, Defendants further contend that emergency relief is unwarranted because the Plaintiffs lack standing and have failed to demonstrate irreparable harm." [City of Columbus v. Kennedy ('Columbus II'), No. 26-2215 (D. Md. complaint filed Jun. 3, 2026)] MORE >>
Video of June 10 hearing, with testimony from [1] Carol Skenes, Turquoise Health; [2] Shawn Gremminger, National Alliance of Healthcare Purchaser Coalitions; [3] Benedic Ippolito, Ph.D., American Enterprise Institute; [4] Christopher Whaley, Ph.D., Brown University School of Public Health; and [5] Sophia Tripoli, MPH, Families USA. MORE >>
"The purpose of the [Patient Refunds for Bad Denials Act (HR 8442)] is to punish health insurers by imposing millions of dollars in fines for claim denial rates exceeding 25%. The bill would not apply to self-insured health plans. The U.S. Department of Health and Human Services (HHS) would increase the maximum fine by $2 million for each percentage point above a 25% claim denial rate, up to a maximum of $10 million. Any fines collected would be distributed to the people covered under the insurer's health policies." MORE >>
"For adults in households below 150% of the federal poverty level (FPL), increases in public insurance coverage were associated with one-for-one decrease in uninsured and no change in ESI. For adults with incomes between 151% -- 400% FPL, each percentage point increase in public coverage was associated with about a 0.6 percentage point decrease in uninsured and a 0.4 decrease, or crowd out, in ESI." MORE >>
"[T]hree actions [that] could move the needle to advance affordability: [1] Policymakers could clarify when ERISA's fiduciary duties apply to [PBMs] and [TPAs], and identify examples of compensation schemes or other contracting and business practices that may violate these duties. [2] Congress could amend ERISA to directly regulate more PBM, TPA, and other service provider conduct, both to enhance oversight over its transparency requirements and to prohibit or limit anticompetitive contracting behavior and other abusive business practices. [3] Congress could provide the DOL with resources and authority to more actively support employers in their role as health care purchasers." MORE >>
"CVS has filed suit to challenge a Tennessee law that would bar pharmacy benefit managers from owning pharmacies in the state.... [In] the lawsuit, CVS argues that the law is designed to target out-of-state players like them while privileging in-state organizations." [CVS v. Tennessee Board of Pharmacy, No. 26-9999 (M.D. Tenn. complaint filed May 22, 2026)] MORE >>
"The terminations leave the panel with just eight sitting members. Five other members saw their terms expire at the start of this year, and Kennedy did not replace them, and the previous chair, Michael Silverstein, departed on his own ... The task force issued fewer recommendations than was typical last year and missed a deadline for a legally mandated report to Congress after Kennedy postponed its meetings indefinitely ... Kennedy is accepting nominations for open positions on the task force, and the nomination deadline is this Saturday, May 23." MORE >>
"The court reasoned that administration of the Code rests with the IRS absent an express delegation of authority to another agency, and that no such express delegation existed here.... Concluding that Letter 226-J satisfied the certification requirement, the court ruled without a trial in favor of the government and denied the employer's refund claim.... This decision creates a split at the trial court level on the question of whether the IRS or HHS has the authority to issue the certification required before an employer shared responsibility penalty can be assessed." [Supreme Linen Services, Inc., v. U.S., No. 25-20723 (S.D. Fla. Feb. 25, 2026; on appeal to 11th Cir. No. 26-11299)] MORE >>
"At its core, [FAB 2026-01] portends agency leadership's intended shift away from broad or aggressive enforcement strategies toward a more disciplined and targeted approach.... EBSA emphasizes its continued commitment to protecting plan participants and beneficiaries, with a focus on where enforcement resources have the greatest impact." MORE >>
"The [Patients Deserve Price Tags Act (S 2355/HR 5582)] would codify and expand current hospital price transparency rules that were established in the first Trump administration by extending requirements to clinical diagnostic laboratories, imaging centers, and ambulatory surgical centers. It would also make the prices that hospitals post clearer by requiring actual dollar-and-cents amounts, not estimates, as well as sharply increase financial penalties for hospitals and insurers that fail to disclose their negotiated rates." MORE >>
"The memorandum, which has no legal effect, was issued by Daniel Aronowitz, Assistant Secretary for EBSA.... The fact that he issued it to the Director of Enforcement of field staff, as well as the field staff, underscores its importance, because the Director of Enforcement issued all prior Field Assistance Bulletins.... The emphasis on not making law by litigation and reducing participant litigation that results only in big payouts for plaintiff class-action lawyers is something the Assistant Secretary wrote about even before being appointed to lead EBSA." MORE >>
"[R]ecent developments underscore a central reality -- while the NSA has succeeded in shielding patients from balance billing for NSA-covered claims, the system operating behind the scenes remains under significant strain and, contrary to congressional intent, is driving up health care costs and creating unintended incentives for certain provider types to remain, or otherwise become, an out-of-network provider. Regulators are aware of these issues and are considering additional actions to address them, but meaningful resolution will likely require additional oversight, rulemaking, and potentially further clarification by the courts." MORE >>
"Key developments loom for healthcare price transparency both legislatively and in the private sector, according to insights from a recent congressional hearing.... Since hospital transparency mandates took effect in 2021, the Biden and Trump administrations have incrementally expanded the requirements. At this month's hearing, [Sen. Bill Cassidy (R-LA)], the chair of the Senate Health, Education, Labor and Pensions (HELP) Committee, suggested recent policy and technological advances have set the stage for price transparency to become embedded in healthcare." MORE >>
"The new rule ... would create a new exempted insurance benefit -- in the same category as dental and vision benefit coverage -- for treating infertility. Exempted benefits don't have to meet certain requirements under the [ACA] and other federal healthcare coverage laws. The proposal wouldn't require coverage but would allow companies to offer it if they choose to do so." MORE >>
"Under the rule, benefits used for diagnosis, mitigation or treatment of infertility or infertility-related reproductive health conditions would be recognized as 'limited excepted benefits' similar to certain dental and vision benefits. The rule would set a combined lifetime maximum cap of $120,000 for participants and their beneficiaries, and this amount would be indexed for inflation from 2028 onward." 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 >>
"[FAB 2026-01] contains a defect that is not merely analytical, but structural: it is internally inconsistent on its face. The Bulletin expressly conditions enforcement on alignment with 'clearly established case law,' yet the governing premise it adopts -- that fiduciary prudence may be satisfied by process alone -- is unsupported by, and in tension with, the very body of law it invokes. That contradiction is fatal." MORE >>
13 pages. "Maryland finalized paid family and medical leave (PFML) regulations in advance of contributions starting next year. New York and Washington, DC, tweaked their PFML laws. Oregon issued guidance on PFML and paid sick and safe leave (PSSL).... Florida, Ohio, and Virginia passed significant pharmacy benefit manager (PBM) laws while Maine clarified a prior law through regulations. New Mexico and South Dakota focused on prior authorization.... Mississippi eased access to association health plans, and a Wyoming law enabled independent contractors to open portable benefit accounts.... San Francisco's new methodology for compliance with the Healthy Airport Ordinance (HAO) started." MORE >>
"Over the past few years, plan sponsors, services providers, and trade associations have been increasingly vocal about issues with EBSA's enforcement. FAB 2026-01 appears designed to address many of the key concerns, including the length of time of investigations and attempts to regulate through enforcement. This represents a fundamental shift in DOL's relationship with the regulated community, though the ultimate impact will depend, in large part, on how it is implemented by the DOL regional offices." MORE >>
"At a House Ways and Means Committee hearing, lawmakers targeted pricing and market power while executives pointed to cost pressures and reimbursement gaps." MORE >>
