"The Consolidated Appropriations Act, 2026 (CAA) (HR 7148) ... added sweeping reporting mandates to ERISA related to the provision of pharmacy benefit management services for ERISA-covered group health plans.... The mandates regulate contracting by group health plans, health insurance issuers offering group health insurance coverage, entities providing pharmacy benefit management services on behalf of a plan or issuer, and 'applicable entities.' "  MORE >>

"With the skyrocketing costs of health care and increased pharmacy spending, the implementation of new PBM reforms was expected. No immediate action is required, but employers should be prepared for restructuring of PBM contracts, reporting and oversight governance. Many of the CAA 2026 reforms are incorporated into ERISA, the Public Health Service Act, and the Internal Revenue Code, and will impact all employer plan sponsors, not just ERISA plan fiduciaries."  MORE >>

"More than 50 lawsuits have been filed against employers challenging their imposition of a premium surcharge on participants who use tobacco.... The recent decisions by the Eastern District of Missouri and the District of Rhode Island mark a potential shift in favor of employers in the current wave of tobacco premium surcharge litigation." [Plesha v. Ascension Health Alliance, No. 24-1459 (E.D. Mo. Feb. 3, 2026)]  MORE >>

"The Federal Trade Commission secured a landmark settlement with one of the nation's largest pharmacy benefit managers (PBMs), Express Scripts, Inc., and its affiliated entities (collectively 'ESI'). The settlement requires ESI to adopt fundamental changes to its business practices that increase transparency, are expected to drive down patients' out-of-pocket costs for drugs like insulin by up to $7 billion over 10 years[.]"  MORE >>

"The Federal Trade Commission and Cigna's Evernorth unit have officially reached a settlement that resolves allegations that the company's pharmacy benefit manager artificially drove up prices for insulin.... Express Scripts agreed to establish a standard offering for plan sponsors where the out-of-pocket costs for patients are based on the net cost of a drug, rather than the list price. It will also provide full access to its Patient Assurance Program to all individuals if insulin is on a formulary, unless the plan sponsor chooses to opt out."  MORE >>

"[T]he FTC alleges these PBMs use of restrictive formularies that completely excluded certain drugs from coverage coerced pharmaceutical manufacturers to provide PBMs higher rebates to avoid exclusion of their products outright from the PBM formularies required for insurance coverage for tens of millions of patients.... The FTC settlement resolves ESI's liability exposure from the FTC lawsuit ... in return for it making significant changes in its PBM pricing and other practices."  MORE >>

13 pages. "Today's employers are confronting a health care landscape increasingly defined by 2 closely related trends: [1] The overall health status of the U.S. population is declining, and [2] health care costs are rising.... Even as the workforce becomes younger, members are growing sicker faster, and overall member spend continues to rise.... By detailing the health and cost trends of members by both age and gender, this white paper can help employers prioritize member engagement efforts. "  MORE >>

25 pages. "To help members overcome barriers to accessing behavioral health care, some health insurers have introduced behavioral health navigation services.... Services are generally available to all members ... with some models tailored to specific populations such as adolescents or people with SUD.... There are currently no widely adopted, formal standards specifically governing the delivery of behavioral health navigation services by insurers."  MORE >>

"[T]he CAA includes several reforms to the pharmacy benefit manager (PBM) industry that represent a major step forward for meaningful health care reform. The PBM provisions included in the final legislation help shine a light on PBM business practices, promote transparency, and ensure that negotiated savings benefit plan sponsors and patients -- not middlemen."  MORE >>