"[CMS] announced the selection of 15 high-cost prescription drugs covered under Medicare Part D and, for the first time, drugs payable under Medicare Part B, for the third cycle of the Medicare Drug Price Negotiation Program. CMS also selected one previously negotiated drug for the program's first renegotiations. Negotiations with participating drug companies will occur in 2026 and any negotiated and renegotiated prices will become effective January 1, 2028."  MORE >>

"The Trump Administration is launching TrumpRx, a platform to connect patients seeking lower cost prescription drugs with direct-to-consumer (DTC) programs offered by manufacturers and other private companies to cash-paying patients. These DTC programs create opportunities for cash-paying patients to obtain prescription drugs at lower prices than may be available through other avenues. This Special Advisory Bulletin explains when a pharmaceutical manufacturer's offer and sale of lower cost prescription drugs to Federal health care program enrollees through a DTC program is low risk under the Federal anti-kickback statute."  MORE >>

"The guidance issued today provides pharmaceutical manufacturers with assurance that they may sell prescription drugs directly to patients who choose to pay cash -- including patients enrolled in federal health care programs -- when the arrangement meets specific conditions. These include ensuring the drug is not billed to Medicare, Medicaid, or other federal programs, is not used to market other federally reimbursable products, and is not tied to future purchases or referrals."  MORE >>

"If you sponsor a group health plan and are required to comply with the new NPP requirements, make sure your NPP is updated accordingly by February 16, 2026.... Although HHS typically provides sample language for the NPP, none has been issued as of this insight's publication. Once finalized, you should distribute the notice within the legal timeframes. For group health plans, the deadline to do so depends on whether the plan posts its notice on a website (as permitted if certain rules are met)."  MORE >>

"Colorado added paid Neonatal Care Leave to its FAMLI program effective January 1, 2026, covering parents of newborns admitted to a neonatal unit or a higher level of care. Eligible parents may take up to 12 weeks of paid Neonatal Care Leave, available only while the newborn remains hospitalized. Neonatal Care Leave is in addition to existing FAMLI benefits."  MORE >>

"Employees are now eligible for PFML leave in a given week only if they are absent at least four consecutive scheduled work hours.... The new law changed which employers are covered ... [E]mployers may limit the ability of employees to extend their leave by stacking PFML and FMLA leave ... Employers must now maintain health insurance coverage for all employees who take PFML leave during their period of PFML job protection, as if they were still working."  MORE >>

"This leave provides up to five paid working days for employees who suffer from, or are suspected of suffering from, the illness or epidemic that gives rise to the state of emergency, in this case, the influenza virus, and must have exhausted all leave to which they were entitled. That is, the employee must have exhausted both vacation leave and regular sick leave before being eligible to use this special leave. Employers must ensure that this new paid leave is recognized in applicable cases."  MORE >>

"The Sixth Circuit explained that 'ERISA's arbitrary-and-capricious standard has both a procedural and substantive component.' However, the court never even reached the substantive component because 'Anthem's coverage decision was procedurally arbitrary and capricious.' The court ruled that this was so because 'Anthem failed to 'engage in reasoned decisionmaking' in three different ways." [T.E. v. Anthem Blue Cross & Blue Shield, No. 25-5407 (6th Cir. Jan. 22, 2026)]  MORE >>

"While these programs may appear to offer 'lower-cost' access, they operate independently of employer health plans and do not reflect negotiated PBM pricing or long-term cost trends.... This article explains what is driving DTC GLP-1 pricing, how it differs from traditional plan coverage, and why employers should view these developments as a member experience and strategy consideration, not a replacement for a clinically guided GLP-1 program."  MORE >>

15 pages. "Unlocking the potential to grow sustainably is a key challenge for many health insurers, especially in the face of high medical inflation driven by medical advancements, heightened geoeconomic uncertainties and ageing societies.... This article explores the use of a capital optimization solutions framework that aims to maximize strategic value from available capital resources while ensuring that firms' regulatory requirements and other business constraints continue to be met."  MORE >>

"Congress has been ... reducing federal health spending through cuts in Medicaid and the ACA tax credits, shifting cost burdens to states and to consumers.... [R]educing health care costs has become a Darwinian game; everyone wants to reduce health care costs and spending -- their own, often at the expense of someone else. It's like a Venn diagram with spending problems that only somewhat overlap and more often conflict."  MORE >>

"[T]he Department plans to continue to devote many more resources to health and welfare plan enforcement. In particular, DOL highlights two projects for 2026: [1] barriers to mental health and substance use disorder benefits (MH/SUD), and [2] surprise billing.... DOL continues to pursue a variety of projects to protect the benefits of retirement plan participants.... [T]he Department for the first time included cybersecurity on the national enforcement project list."  MORE >>

"[T]he Part B premium will rise from $185 in 2025 to $202.90 per month in 2026.... Part B premiums as a share of annual Social Security benefits -- defined as the benefit for the retired workers with average pre-retirement earnings -- will reach an all-time high of 9.4 percent."  MORE >>

"Workers reported similar satisfaction with their benefits package as in prior years, with top suggestions for improvement being a greater employer contribution and more flexibility of benefits to choose from.... Workers were somewhat open to using artificial intelligence (AI) as a tool to help navigate benefits and finances, but significant shares were skeptical."  MORE >>