News Archive

"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 >>

"The complaint alleged Apex Management Group I Inc.... operated a multiple employer welfare arrangement that provided essential minimum coverage health plans to hundreds of small employers ... In its complaint, the [DOL] alleged Apex and [one of its owners] acted as fiduciaries to each plan, violated their fiduciary duties, and engaged in prohibited transactions by causing the plan assets of some of the plans to be used to pay claims of other plans, comingling assets of unrelated plans, and causing plans to pay undisclosed and excessive compensation to Apex -- all in violation of ERISA." [Sonderling v. Apex Management Group I, Inc., No. 24-3609 (N.D. Ill. Apr. 28, 2026)]  MORE >>

"DOL will prioritize investigations of the most egregious violations, provide advance notice of the agency's ERISA interpretations, commit to completing investigations within reasonable timeframes, and require senior leadership to review significant enforcement matters. Agency leadership believes these principles will promote 'transparency, consistency, and the rule of law.' [FAB 2026-01] doesn't explain how DOL will apply these principles to investigations and enforcement actions that are already in progress."  MORE >>

"As to civil (not criminal) enforcement, [FAB 2026-01] establishes a clear lodestar. The emphasis is to be on breaches of the duty of loyalty ... [E]nforcement activities need to have a close connection with: [1] The plain language of ERISA's text, [2] Clearly established guidance in final DOL regulations or prominently published sub-regulatory guidance, or [3] Clearly established court decisions.... [T]he DOL's Assistant Secretary must be informed by field personnel of 'significant enforcement activity,' which is to include any proposed settlements or voluntary corrective actions.... EBSA investigators and professionals must not do anything that compromises the DOL's independence, integrity, and credibility with the regulated or participant communities."  MORE >>

Video of Apr. 28 hearing. Opening statement by Chairman Jason Smith (MO-08); witness testimony from [1] Mr. Sam N. Hazen, HCA Healthcare; [2] Mr. Wright Lassiter III, CommonSpirit Health; [3] Dr. Brian G. Donley, New York-Presbyterian; [4] Dr. Michael Waldrum, ECU Health; and [5] Mr. Brad Woodhouse.Protect Our Care.  MORE >>

Video of April 22 hearing, with Opening Statement from Subcommittee Chairman Rep. Rick Allen (R-GA), and witness testimony from: [1] Mr. James Gelfand, The ERISA Industry Committee (ERIC); [2] Mrs. Chris Deacon, VerSan Consulting; [3] Professor Mariana Socal, Johns Hopkins Bloomberg School of Public Health; and [4] Ms. Hannah Anderson, America First Policy Institute.  MORE >>

"[FAB 2026-01] is a positive development for plan sponsors and fiduciaries, as on the whole it suggests a more restrained and targeted enforcement approach: Likely fewer investigations overall, particularly those based on novel or unsettled legal theories or on ESOP valuations. Greater focus on clear-cut violations, especially those involving conflicts of interest or significant participant harm. Increased focus on fiduciary duty of loyalty and reduced emphasis on standalone prudence claims, absent loyalty concerns. More centralized decision-making within EBSA, leading to greater consistency across regions."  MORE >>

"Employers, lawmakers, patient advocates, price transparency groups and more urged the [DOL] to quickly finalize a rule that would force pharmacy benefit managers ... to share more pricing and compensation information. PBMs did not feel the same, according to industry comments on the proposed regulation."  MORE >>

"One of the most notable aspects of [FAB 2026-01] is that EBSA plans to focus its enforcement efforts on cases that pose meaningful harm to the employee benefits system, especially those involving bad faith conduct.... They have an express focus on breaches of the fiduciary duty of loyalty. However, just as important, the DOL emphasized that ERISA is a 'law of process, not results.' ... [T]he agency says it generally won't second‑guess fiduciary decisions where a prudent process was followed."  MORE >>

"[T]he Memorandum represents a significant recalibration of EBSA's enforcement approach with the apparent intent of providing greater predictability for plan sponsors and fiduciaries. Plan fiduciaries should nonetheless remain vigilant, particularly with respect to the enforcement priorities included in the Memorandum."  MORE >>

"Aronowitz testified that fiduciaries are 'paralyzed with very rational fears' about litigation, and this 'stifles innovation in plan design' to the detriment of plan participants. Many of these lawsuits amount to 'unfair, hindsight second guessing,' he argued. He added that many fiduciary meetings focus on avoiding litigation rather than helping their participants."  MORE >>