"To prepare for the possibility of the continued absence of an appropriation that could be used to fund CSR payments to issuers, and in light of the adverse effect that CSR loading can impose on premiums for unsubsidized consumers, CMS is issuing this bulletin to encourage states that permit CSR loading to consider requiring issuers that load QHP premiums to offer and market unloaded plans that are available exclusively outside the Exchange."  MORE >>

"[Executive Order 14273] mandates agencies to evaluate and regulate PBMs, requiring greater transparency in their compensation and role in drug pricing. The EO reinforces requirements for health plans to disclose actual drug prices and outlines new enforcement measures."  MORE >>

"Key directives and implications for employer plans: [1] Oversight of middlemen ... [2] Expanded drug importation ... [3] Transparency from PBMs ... [4] Generic and biosimilar market acceleration ... [5] Prescription-to-OTC reclassification ... [6] Medicare changes."  MORE >>

"There are currently six states with active Prescription Drug Affordability Boards (PDABs)  ... As PDABs march toward declaring the price of certain drugs to be unaffordable for state residents and establishing a maximum price or reimbursement for certain drugs in their states, some pharmaceutical manufacturers have begun to challenge the constitutionality of PDABs in court. In March, a federal court in Colorado tossed out one of these suits on the basis that the manufacturer lacked the requisite standing." [Amgen Inc. v. Colorado Prescription Drug Affordability Review Bd., No. 24-0810 (D. Colo. Mar. 28, 2025)]  MORE >>

"Health and welfare plan sponsors will find that many vendors already emphasize cybersecurity.... [T]he DOL's guidance serves as a valuable checklist for sponsors to evaluate their service providers through a fiduciary lens.... [S]ponsors should assess their internal cybersecurity measures, especially if they retain sensitive plan-related data. ERISA's 'prudence' requirement hinges on adopting a sound process -- a hallmark of effective fiduciary responsibility."  MORE >>

"The annual contribution limits, HDHP minimum deductibles, and HDHP maximum out-of-pocket limits will be increasing. The additional annual catch-up contribution limit (for account holders age 55 and older) will remain the same."  MORE >>

"[The authors] find that child maltreatment reports decline by 11% following the adoption of a state paid sick leave mandate. An analysis of mechanisms suggests that increases in parental and child health, family economic standing, childcare provision, and healthcare are important channels linking paid sick leave mandates to child maltreatment reports."  MORE >>

"there are only three entities in the U.S. that ultimately pay for healthcare: [1] The government/taxpayer (via programs like Medicare, Medicaid, or the VA); [2] Insurance companies (as the actual payer in fully insured and individual-market plans); [3] Employers (when they self-fund and become the payer directly). And among those three, the employer is -- by far -- the least conflicted and the most amenable to optimization."  MORE >>

"Under Section 406 of ERISA, every payment that an ERISA-covered plan provides to a service provider is automatically a prohibited transaction. In order to pay service providers, such as recordkeepers, a plan would normally rely on Section 408 of ERISA ... Under Cornell, plaintiffs can bring a claim based solely on the fact that the plan is paying its service providers, despite the exemption for retirement plan recordkeeping, investment advisor and other standard plan-related service providers." [Cunningham v. Cornell Univ., No. 23-1007 (S.Ct. Apr. 17, 2025)]  MORE >>

"We can expect that ERISA fiduciary breach lawsuits will nearly always feature a prohibited transaction claim going forward. Hopefully, district courts will take seriously the mitigating steps suggested by the Supreme Court. Having said that, the decision does not change the steps that retirement plan fiduciaries should be taking now to build a proper defense." [Cunningham v. Cornell Univ., No. 23-1007 (S.Ct. Apr. 17, 2025)]  MORE >>

"The more vendors you work with, the greater the chance you'll be impacted by a cybersecurity incident affecting one of them.... [E]very vendor you work with likely works with other vendors, increasing the probability that you'll be affected by an incident.... If a vendor cannot provide an objective, third-party cybersecurity assessment, like a SOC2 report or other attestation, showing that it has solid cyber protections in place, that's a red flag."  MORE >>