"The proposed regulations would only apply to ERISA plans, not governmental or church plans, and for now are limited in scope to self-funded plans, though the DOL has left space in the proposed regulations to expand to fully insured plans in the future.... The rules build upon the statutory framework established by ERISA Section 408(b)(2)(B), which requires group health plan sponsors to request and review fee information from 'covered service providers' to demonstrate the reasonableness of the arrangement under ERISA's prohibited transactions requirements."  MORE >>

"Following Arkansas's efforts last year, several states are considering or advancing proposals that would restrict or prohibit [PBMs] and affiliated entities from owning or controlling pharmacies. While the proposals vary in structure and timing, each reflects ongoing state‑level interest in limiting PBM pharmacy ownership, with some measures drawing from aspects of the Arkansas approach."  MORE >>

"An expansion of the New York City Earned Safe and Sick Time Act will take effect February 22....[E]mployers in the City will be required to allow employees to use ESSTA leave for these additional reasons: [1] To provide care for a minor child or care recipient. [2] To attend legal proceedings for subsistence benefits or housing. [3] For certain reasons related to a public disaster or workplace violence."  MORE >>

"[A] key question that courts will have to grapple with in each of these cases is whether the plans fall outside the ambit of ERISA in accordance with the [DOL's] 'voluntary plan' safe harbor ... Plaintiffs maintain that the employers lacked any process to review, select or monitor carriers and brokers or to confirm that broker commissions were reasonable. They further allege ERISA prohibited transactions, asserting that employers and brokers caused the payment of excessive commissions from plan assets."  MORE >>

"PMCA's arguments in favor of ERISA preemption of the fiduciary standards provision for self-funded employer plans center around three main points: [1] It makes an impermissible reference to ERISA plans because it specifically references 'self-insured employer plans'; p2[ It regulates in a field already fully occupied by federal standards ... and [3] It requires plan sponsors to design or structure their plan in a particular way[.]" [Pharmaceutical Care Management Association v. Bonta, No. 26-0012 (C.D. Calif. complaint filed Jan. 2, 2026)]  MORE >>

"Healthcare affordability for employers in 2026 requires a three-pronged approach: [1] Active management of high-cost pharmacy drivers like GLP-1s. [2] Optimized Health Savings Account (HSA) plan designs. [3] Integration of Artificial Intelligence (AI) to streamline benefits education."  MORE >>

"Rising healthcare costs and unpredictable renewals are pushing more employers to explore self-funded insurance as a smarter alternative to fully insured plans.... A typical self-funded plan includes: [1] Third Party Administrator (TPA) ... [2] Stop-Loss Insurance ... [3] Pharmacy Benefit Manager (PBM) ... [4] Targeted support for areas like diabetes, MSK, or mental health ... [5] Alternative pricing strategies including reference-based pricing."  MORE >>

"The cost for a patient with one chronic condition was nearly double that for a patient with no chronic conditions ... The average allowed amount for a patient with no chronic conditions was $1,590, while the average allowed amount for a patient with one chronic condition was nearly double ($3,039). Of 44 common chronic conditions studied, hyperlipidemia, or high cholesterol, was the most common, with a crude prevalence of 21.2 percent."  MORE >>