33 pages. Topics: [1] Washington update: One Big Beautiful Bill; [2] Federal legislation and regulations; [3] Health benefits litigation update; [4] Prescription drugs; [5] Preventive services and fertility benefits; [6] Year-end reminders.  MORE >>

"Examples of gag clauses include a requirement in a PBM contract that prevents the disclosure of lower-priced alternative prescription medications. Such a requirement would constitute a gag clause, since it could prohibit disclosure of pricing information or disclosure of the fact that a medication may be cheaper without insurance. A gag clause would also include a provision in a provider contract with a plan that maintains the confidentiality of negotiated rates or quality metrics."  MORE >>

"There are a variety of mistaken elections that can occur each year. They may be made by employees out of confusion, the result of bad programming in the enrollment platform, or mistaken paper election.... [This article discusses] the parameters of correcting cafeteria plan elections."  MORE >>

"While the FAQs do not change any existing rules governing fertility-related benefits, and from a practical perspective will not likely change how most employers currently structure these benefits, they do illustrate the increasing attention these benefits are attracting. Presently, nearly half of states have passed fertility related insurance coverage laws, and the federal government has expressed its commitment to expanding access to affordable fertility treatments"  MORE >>

"Minneapolis and Saint Paul recently amended their Earned Sick and Safe Time ordinances to align more closely with Minnesota's statewide law. Employees are covered under the city ordinances if they are expected to work at least 80 hours in a year within the respective city's limits."  MORE >>

"[The amended regulations] take effect on December 11, 2025 ... [and] will significantly impact many employers set to comply with the new program on January 1, 2026.... [T]he amended regulations [1] alter the definition of the 'application year,' which is used to determine benefit entitlement.... [2] modify the definition of 'employee.' ... [3] address the contributions that can be deducted from employee pay in certain circumstances.... [4] provide guidance for self-insured employers, particularly regarding requirements for claim reserve accounts, and modify information collected by the state."  MORE >>

"[T]he court found that the connection between what plan participants were required to pay in contributions and out-of-pocket costs and the fees the plans were required to pay the PBM was too tenuous. The court cited to J&J's discretion in setting participant contribution rates, which it stated can be influenced by multiple factors unrelated to amounts paid in connection with the prescription drug benefits." [Lewandowski v. Johnson & Johnson, No. 24-0671 (D.N.J. Nov. 26, 2025)]  MORE >>

"Just a few weeks after CVS Pharmacy Inc. agreed to pay $18.2 million dollars to resolve alleged violations of the federal and California False Claims Acts ... CVS has once again agreed to pay almost $37.76 million dollars to settle another civil fraud case brought against it by the Department of Justice.... In the stipulation and order of settlement and dismissal, CVS admits, acknowledges and accepts responsibility for being overpaid by government healthcare programs, over dispensing and refilling prescriptions too soon."  MORE >>

"A senior account manager took eight and a half days of paid time off to care for a seriously ill daughter and then her mother. She later claimed the company interfered with and retaliated against her Family and Medical Leave Act (FMLA) rights. The Second Circuit affirmed summary judgment for the employer because performance issues were documented before the leave, every leave request was approved, and there was no proof that criticism or the termination decision was tied to her time off." [Haran v. Orange Business Services, Inc., No. 24-2312 (2d Cir. Nov. 25, 2025)]  MORE >>

"[T]he court noted that an employee's subjective feelings are not in themselves enough to establish a valid claim.... The Second Circuit panel ... found that the employer's failure to provide the notices did not support Patti's interference claim. No prejudice.... The employer said that Patti was doing a lousy job with U.S. clients. Patti disagreed, and said that her contrary opinion was enough to get her FMLA retaliation claim to a jury. But the court correctly noted that her personal opinion was not relevant.... [T]he employer's performance-related feedback had been consistent the whole time -- before, during, and after the FMLA leave." [Haran v. Orange Business Services, Inc., No. 24-2312 (2d Cir. Nov. 25, 2025)]  MORE >>

"[Some] are pitching the accounts as an alternative to expiring enhanced federal subsidies that have lowered insurance premium payments for most Americans with [ACA] coverage. But legal limits on how HSAs can and can't be used are prompting doubts that expanding their use would benefit the predominantly low-income people who rely on ACA plans.... One group that would almost certainly benefit: a slew of companies selling expensive wellness items that can be purchased with tax-free dollars from the accounts."  MORE >>

"[M]aking patients bear more of their costs out of pocket is a bad way to reduce wasteful health-care spending. It does more to inhibit access to care than to steer patients to cheaper sources of treatment. This is because health-care spending is highly concentrated among the seriously ill, for whom additional expenditures greatly exceed any realistic deductibles. Legislators should instead focus on letting Americans purchase more affordable insurance plans that are better focused on their health needs."  MORE >>