"HHS estimates that overall, the cumulative impact of the proposed rules could reduce enrollment by up to two million consumers.... [K]ey changes included in this proposed rule: [1] Changes for 2026 AV de minimis ... [2] Maximum out of pocket ... [3] Increased documentation requirements ... [4] Restriction on premium payment thresholds ... [5] Shortening open enrollment period ... [6] Auto-enrollment changes ... [7] Changes to essential health benefits (EHB)."  MORE >>

"These Executive Orders do not provide direct guidance as to how group health plans must adopt these rules. Still, they could affect group health plans in the future depending on what actions federal governmental agencies take[.]"  MORE >>

"The PCORI fee for plan years ending on or after October 1, 2024, and before October 1, 2025, will be $3.47 per covered life.... Payment is due by July 31 of the year following the last day of the plan year. For plan years ending in 2024, the PCORI fees are due by July 31, 2025. Employers who sponsor self-insured plans subject to the PCORI fee are responsible for filing Form 720 and paying the fee. Self-insured health plans should speak with their TPA to determine the number of lives for payment."  MORE >>

"While directed at federal agencies, [recent Executive Orders] signal a shift in the administration's opinions that may trickle down to states ... This alert also includes an overview of other pressing state news updates and benefit issues from the past quarter, including new rulemaking for existing state programs.... The executive orders issued on gender-affirming care are inconsistent with some state laws and many states have promptly responded with their own directives to continue providing gender-affirming care under state law requirements."  MORE >>

"The definition of 'family member' is revised to include any individual who regularly resides in the employee's home and 'who has a relationship with them that creates an expectation that they would take care of them during an illness.' ... 'Child' now also includes the spouse of the employee's child. 'Grandchild' and 'grandparent' will be defined to mean the employee's grandchild or grandparent."  MORE >>

"One set of allegations unique to Stern is that JPMorgan breached its ERISA fiduciary duty of prudence by failing to 'recognize[] and avoid[] the flaws' in their approach to procuring prescription drug coverage for their employees which they should have known through their 'own business and trade experience.' ... Also unique to Stern is a prohibited transaction claim alleging that JPMorgan's PBM, Caremark, is a service provider and party in interest under ERISA and that Caremark is also 'vertically integrated with CVS, which is a JPMorgan banking client.' " [Stern v. JPMorgan Chase & Co., No. 25-2097 (S.D.N.Y. complaint filed Mar. 13, 2025)]   MORE >>

"Whether or not ERISA preemption could affect some or all of the provisions of the state PBM law will depend on the terms of the actual law being implemented and the courts' interpretation of that law.... While some of these laws' requirements (such as reporting/attestation) apply directly to self-insured plans, most of them regulate PBMs. Nonetheless, they may impact the terms of the underlying ERISA covered group health plan (both fully and self-insured prescription drug plans) in certain instances."  MORE >>

"Pharmacy benefit managers have traditionally compensated pharmacists more for cheaper generic medicines to encourage their use, said Patrick Conway, chief executive officer of UnitedHealth's Optum Rx unit. But generic adoption has plateaued, and Conway said the old system discouraged some pharmacies from stocking newer branded drugs like diabetes and weight-loss shots."  MORE >>