"RxDC reporting is required for all group health plans, including fully insured, self-insured and level-funded health plans. The RxDC report is comprised of several files, including those that require specific plan-level information, such as plan year beginning and end dates and enrollment and premium data. It also includes files that require detailed information about medical and pharmacy benefits."  MORE >>

"Arkansas has become the first state in the national to enact legislation, effective starting in 2026, prohibiting pharmacy benefit managers (PBMs) from owning or operating actual pharmacies within the state.... Unfortunately for employers (including employers with self-funded plans governed by ERISA), there may be limited options for the forthcoming disruption."  MORE >>

"[T]he McKee court held that Tennessee's 'any willing pharmacy' law had an impermissible connection with ERISA plans and was therefore preempted. In so holding, the court rejected the state of Tennessee's reliance on Rutledge. Critically, Rutledge involved a form of cost regulation, not plan structure. By contrast, pharmacy networks -- at issue in McKee -- are plan structures." [McKee Foods Corporation v. BFP Inc., No. 21-0279 (E.D. Tenn. Mar. 31, 2025)]  MORE >>

"[T]he employer did not use [DOL's] Model COBRA notice, and instead, provided a notice that, among other things, provided incorrect or inconsistent information about the time period for her to make an election and the required time for making COBRA payments.... [The employee] claimed that her failure to enroll in COBRA continuation coverage was due to deficiencies in the employer's COBRA notice." [Marrow v. E.R. Carpenter Company, Inc., No. 23-2959 (M.D. Fla. Feb. 4, 2025)]  MORE >>

"A former employee alleged that her employer violated the [FMLA] by terminating her health benefits while she was on leave. Although the employer disputed the allegation, contending that it had not cancelled the employee's coverage, the court held that this was not material since the employee's claim failed as a matter of law because she admittedly had failed to pay her share of the health plan premiums." [Kliskey v. Making Opportunity Count, Inc., No. 22-40123 (D. Mass. Mar. 31, 2025)]  MORE >>

"Though the cases thus far have been dismissed for lack of standing, health plan sponsors should consider reviewing their prescription drug arrangements (particularly the associated costs) and documenting a prudent fiduciary process in selecting and monitoring the health plan's service providers."  MORE >>

"With fiduciary liability exposures increasing, having appropriate insurance coverage in place is important. Plan sponsors ... must understand the limitations of different kinds of policies, so they can ensure optimum risk transfer for fiduciaries and executive leadership teams.... While insurance can serve as an important backstop in the event of losses, plan sponsors should also take additional steps to promote diligence in plan administration."  MORE >>

"By the end of 2026, 25-30% of all medical visits in the United States will be conducted via telemedicine. Although the adoption rate of telemedicine has been low in 2024, it will grow considerably with regulatory support from the US Congress."  MORE >>

"Approximately 200 employees of the Employee Benefits Security Administration have accepted recent resignation or retirement offers. EBSA had funding for about 889 full-time employees (FTE) in fiscal year 2024."  MORE >>

"To ensure the ability to quickly dispel a prohibited transaction claim, plan fiduciaries should consider taking the following steps: ... [1] Assess the viability of the plan sponsor covering recordkeeping costs instead of the plan.... [2] Maintain comprehensive documentation ... [3] Review and update fiduciary processes ... [4] [Be] prepared to articulate and demonstrate the applicability of an exemption at an early stage in the litigation." [Cunningham v. Cornell Univ., No. 23-1007 (S.Ct. Apr. 17, 2025)]  MORE >>

"What plans does ERISA cover (and exclude)? ... Key legal differences in ERISA vs. Non-ERISA plans ... Special considerations applied to different types of benefits (health, disability, and retirement) ... Determining ERISA plan status: how to know if ERISA applies ... Recent legal developments and impact ... When to seek legal guidance for an ERISA or non-ERISA claim."  MORE >>

"Jeffrey D. Mamorsky ... died on April 21 at age 79. Jeff was a trailblazer in the field of employee benefits law, and his contributions to the legal profession and the lives of countless individuals over the past five decades were both profound and enduring."  MORE >>