"This Executive Order calls for 'improving transparency into pharmacy benefit manager fee disclosures' by requiring that the [DOL] propose additional regulations specific to already existing employer health plan 408(b)(2) disclosures. The order does not specify whether these regulations must be limited to pharmacy benefit manager compensation, or whether they might also apply more broadly to other broker activities currently covered by employer health plan 408(b)(2) disclosures."  MORE >>

"The Executive Order’s directive to the DOL contemplates that DOL will revise its existing regulations under Section 408(b)(2) to prohibit group health plan fiduciaries from allowing PBMs to directly or indirectly receive compensation for their PBM services unless the PBM discloses its compensation from the arrangement in accordance with the fee disclosure requirements that the Executive Order contemplates DOL will add to ERISA section 408(b)(2)."  MORE >>

"Because the special enrollment notice contains practical information that a participant might need in deciding whether to enroll in the plan, ... group health plan sponsors [should] include the notice with plan enrollment materials. While special enrollment information should also be included in the plan's summary plan description (SPD), that alone would likely be insufficient because employees who decline coverage are usually not given an SPD and therefore would not receive the required notice."  MORE >>

"The Supreme Court will hear oral arguments in a lawsuit consequential for the fate of preventive services April 21.... Both the Biden and Trump administrations have argued in favor of keeping in place the U.S. Preventive Services Task Force (USPSTF), a body the plaintiffs find to be unconstitutional. The task force is an independent panel that looks at new scientific developments to make evidence-based recommendations about preventive services." [Braidwood Mgmt, Inc. v. Becerra, No. 23-10326 (5th Cir. Jun. 21, 2024; cert. pet. granted Jan. 10, 2025)]   MORE >>

"The named plaintiff alleged that obesity is a disability and her health plan unlawfully discriminated against her and the putative class because the benefit design of the plan excludes coverage for weight loss medications in violation of ... section 1557 of the [ACA]." [Holland v. Elevance Health Inc., No. 24-0332 (D. Me. Apr. 9, 2025)]  MORE >>

"A SIHRA technically combines two separate benefit strategies: a Health Reimbursement Arrangement (HRA) with a spousal incentive/surcharge. As with a typical HRA, the account is funded solely by the plan sponsor.... [W]hile this account type is permitted under ACA how an employer implements it will matter. Here are a couple things to consider."  MORE >>

"Recent [DOL] investigations into fiduciary failures highlight the importance of adhering to best practices when monitoring third-party administrators (TPAs), pharmacy benefit managers (PBMs), and other vendors. Implementing best practices is critical to addressing potential risks."  MORE >>

"This report examines [1] how health coverage among students has changed since the enactment of the [ACA] and barriers students face in obtaining coverage, [2] factors selected colleges considered in deciding whether to offer health coverage and how these colleges helped students navigate coverage options, and [3] federal agencies' actions to support colleges' efforts to help students obtain coverage." [GAO-25-107024 pub. Mar 21, 2025, rel. Apr 17, 2025]  MORE >>

"In their letter to Acting Commissioner Shapley, Chairman Smith, Health Subcommittee Chairman Buchanan, and Ways and Means Committee Member Representative Panetta detail the prevalence of chronic disease and the extent to which treatments drive a substantial amount of the nation's health care spending -- underscoring the need for expanding coverage to additional treatments."  MORE >>

"[T]his is the first time President Trump has been this specific ... And it may be the first time any president has focused so explicitly on PBMs in an executive order.... [T]he president's order should be taken as a clear signal to lawmakers to pass PBM reform now."  MORE >>

"The Court did offer some guidance to lower courts presented with barebones prohibited transaction claims. The Court proposed, for example, invoking the rarely-used provisions of Fed. R. Civ. P. 7(a)(7) to require plaintiffs to file a reply to an answer to plead how an exemption does not apply (and then dismissing suits if plaintiffs cannot do so). The Court also cautioned that Rule 11 sanctions and ERISA’s fee-shifting provision can be used as deterrents where plaintiffs seek to capitalize on the lower pleading standard created by this opinion." [Cunningham v. Cornell Univ., No. 23-1007 (S.Ct. Apr. 17, 2025)]   MORE >>