"[IRS] announced that it extended the grace period for states and employers to report tax information about benefits paid through a state's paid family and medical leave program. For 2026, states and employers will not have to comply with tax and income reporting obligations related to those benefits.... Thirteen states and Washington, D.C., have enacted state-run paid family and medical leave programs."  MORE >>

"Effective for the 2025 plan year, OBBBA reinstated and made permanent COVID-19-era telehealth relief allowing HSA-compatible high-deductible health plans (HDHPs) to cover telehealth and other remote care services before the statutory minimum deductible is satisfied. Beginning Jan. 1, 2026, OBBBA also allows individuals enrolled in certain direct primary care service arrangements to remain eligible to make or receive HSA contributions and treats certain bronze and catastrophic plans as HDHPs. This article summarizes provisions of Notice 2026-5 most relevant to employers."  MORE >>

"The two models -- GLOBE for Medicare Part B and GUARD for Medicare Part D -- will factor in international prices into the inflationary rebates drug manufacturers must pay to the program for certain single-source drugs and sole-source biologics that are separately payable under Medicare Parts B and D, if CMS finalizes the rule."  MORE >>

"The plaintiff is challenging the Iowa law requiring that, among other provisions, 'any willing pharmacy' be included in a prescription drug plan's provider network, including self-insured prescription drug plans governed by ERISA. In October, a federal judge blocked enforcement of several portions of the law, citing potential conflict with ERISA. In its brief, ERIC argued that ERISA preempts Iowa's law because that law directly interferes with prescription-drug benefit plan design and administration [.]" [Iowa Assoc. of Bus. and Ind. v. Ommen, No. 25-0211 (S.D. Iowa Jul. 21, 2025; on appeal to 8th Cir. No. 25-2494)]  MORE >>

19 pages. "The need for long-term reforms to Medicare has been repeatedly raised. One is to raise the eligibility age from 65 to the Social Security full retirement age of 67, then tie it to increases in longevity.... In this paper, [the authors] estimate the coverage and spending effects of eliminating Medicare coverage for those ages 65 to 66[.]"  MORE >>

"Among states in 2023, the highest average in-network denial rate was 34% (Alabama), with the lowest in South Dakota (6%), perfectly illustrating the wide national variance in claim denials. Whereas, in Florida, the average in-network denial rate was 16%, with individual insurers varying between 8% to 54%, emphasizing the potentially enormous non-network differential."  MORE >>

"[T]wo areas [for PBMs to] focus on in the coming months ... [1] Operate with full clarity on money flow and decision-making (i.e., clearly defined administrative fees) while making the whole process accessible and visible to your clients.... [2] [C]harge a clear administrative fee and return every rebate and discount to the client. This can help your PBM regain trust and relieve some of the strain that could lead clients to seek alternate options."  MORE >>