"This final rule revises various existing standards and methodologies in the [ACA] with a focus on reducing waste, fraud and abuse in the ACA's eligibility and enrollment systems. Most changes affect access to plans on the exchange and access to subsidies. Some changes go into effect in 2025, and some start in 2026 or later."  MORE >>

"The average stop-loss coverage premium increase is 9.7 percent ... for groups that maintained similar specific stop-loss benefit levels as the prior year. Among all groups, including those that increased specific stop-loss deductible levels and/or aggregating specific stop-loss deductibles resulting in an overall reduced rate action, the average premium increase is 7.3 percent."  MORE >>

"The pledge is a voluntary commitment by select insurance carriers to make the changes included in the pledge.... The pledge includes specific performance metrics and dates by which stated requirements will be met; however, it does not include any type of reporting on whether these items have been satisfied. Not all insurance carriers have committed to the pledge so far."  MORE >>

"Specialty drugs now represent 51% of healthcare costs ... The broader specialty pharmaceutical market is anticipated to grow from $16.03 billion in 2025 to $75.94 billion by 2030, representing a [compound annual growth rate] of 36.50% ... By expediting claims processing, proactively managing prior authorizations, and centralizing case management, payers can significantly reduce delays, cut administrative waste, and improve the member experience."  MORE >>

"[N]early one in three organizations are evaluating unbundled PBM models. Modular frameworks allow plan sponsors to separate individual services and choose specialized partners based on performance, value, and strategic fit. This shift brings greater control and agility, both of which are often limited in traditional PBM arrangements. One of the main drivers behind this movement is transparency.... Technology is also a major factor."  MORE >>

"[O]nly 14% of Americans think that health insurance plans should cover GLP-1s ... when they're prescribed solely for weight loss.... GLP-1s are already being overprescribed, and adding them for general weight loss in a self-funded plan is a fast way to blow a hole in your budget.... What if a very generous employer says, 'Look, we'll pay half of it.' ... And then the employer gives employees the choice ... No threat. No reduction. Just: 'Do you want to add this benefit and pay for it?' "  MORE >>

"[The Filing Relief for Natural Disasters Act] allows the Treasury Department ... to postpone filing deadlines for affected individuals and businesses in a state-declared disaster area that has not yet received a federal disaster designation.... The Act also increases the current automatic extension following a federally declared disaster declaration from 60 days to 120 days."  MORE >>

"[The plaintiff] achieved substantial success, but the courts drew a clear line: once the plan reversed its denial and paid the claims, the remaining litigation did not justify further fee recovery. The case highlights the importance of focusing fee petitions on work that demonstrably contributes to obtaining or securing benefits under the plan." [Canter v. Alkermes Blue Care Elect Preferred Provider Plan, No. 24-3926 (6th Cir. Jul. 23, 2025)]  MORE >>

"Failure to timely respond to discovery requests -- particularly Requests for Admissions -- can result in severe consequences, including conclusive findings that effectively decide the case. Moreover, employers who do not maintain clear records or who fail to participate diligently in litigation risk significant monetary judgments and preclusion from presenting defenses." [Cement & Concrete Workers Dist. Council Welfare Fund v. Manny P. Concrete Co., No. 23-1030 (2d Cir. Jul. 21, 2025)]  MORE >>