"The district court found that Defendants made material misrepresentations upon which Bunner reasonably and detrimentally relied but that she did not rely on them under extraordinary circumstances.... The [Fifth Circuit] affirmed the district court's grant of summary judgment and its ruling regarding ERISA estoppel." [Bunner v. Dearborn National Life Ins. Co., No. 21-20327 (5th Cir. June 15, 2022)]  MORE >>

"Protective steps include forming a benefits committee, getting fiduciary training, do periodic market checks, purchasing fiduciary liability coverage and of course, following the rules [the authors have] described in this series. These protective measures can help not only the employer, but also their employees acting in fiduciary capacities, as individuals can be held personally liable for breaches of fiduciary duties."  MORE >>

"The FTC's June 7 decision signals that PBMs are now in the regulatory sights of both federal and state lawmakers. In particular, the topics the FTC will be investigating as part of its inquiry mirror what many states have already begun to regulate with new state PBM legislation: pharmacy clawbacks and fees, steering of patients to PBM-owned or affiliated pharmacies, pharmacy audit practices and greater transparency with rebates and pricing methodologies."  MORE >>

"Health insurers serving individuals and companies in the state are requesting increases as high as 30 percent in some cases, although the weighted average is 18.7 percent for individuals and 16.5 percent for the so-called small group employer market that includes companies under 100 people."  MORE >>

"The new state law requires PBMs to update weekly their list of reimbursement rates to pharmacies; allows pharmacies to disclose or sell lower-cost prescriptions to covered individuals; and creates a framework for the state insurance commissioner to gather data on PBMs' activity in the state."  MORE >>

"[R]eceiving a COVID-19 vaccine reduces the likelihood of delaying care for any medical condition by 37 percent.... [I]ncreased vaccine uptake has a positive, albeit statistically insignificant, effect on consumer healthcare spending in the short run.... The decline in delayed or foregone care caused by vaccination is particularly strong among minorities and those with a low socioeconomic background[.]"  MORE >>

"The due date may be extended if Form 5558 is properly filed with the IRS by the due date.... The information entered onto a Form 5558 should match the Form 5500 and the plan ... [R]ecognize it is your filing made under penalty of perjury; not that of a service provider who may have populated the form ... An auditor might sample some compliance issues and/or instances of late deposits; however, the process is not a comprehensive analysis of a plan's legal compliance."  MORE >>