19 pages. Topics: [1] Federal legislation and regulations; [2] Administration healthcare proposal; [3] Deep dive on Notice 2026-5; [4] Litigation update; and [5] Grab bag.  MORE >>

"[O]ne of the most significant parts of the law -- the delinking of PBM compensation from the price of a drug in Medicare Part D -- eluded employer groups. This is a provision in the new law that only applies to Medicare Part D.... Employers ... didn't get a ban on spread pricing ... What the law does include for employers is a requirement for PBMs to provide more detailed reporting to plan sponsors ... In addition, PBMs are mandated to pass along all rebates, discounts, fees and other payments they receive on drugs directly to employers or group health plans."  MORE >>

"The proposal builds on recent national efforts to lower healthcare costs and reinforce transparency across the supply chain. By holding PBMs accountable and requiring them to operate in full view of the plans they serve, the rule is designed to empower employers to negotiate more favorable terms and ultimately reduce prescription drug spending. If finalized, the regulation represents a decisive step towards a more transparent pharmacy benefits system -- one that aligns business practices with the interests of workers and their families."  MORE >>

"An employee's medical condition may implicate both the Americans with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA) at the same time, but the two laws use distinct eligibility frameworks and impose different obligations for employers. Understanding the differences between the two laws, and where they overlap, is critical to compliant leave and accommodation administration."  MORE >>

"The court applied abuse‑of‑discretion review and concluded that the denial was supported by the plan's medical‑necessity criteria and the administrative record. The dissent, however, argued that the majority failed to meaningfully account for a structural conflict of interest and for the administrator's handling of treating‑provider evidence and prior failed lower levels of care." [R.R. v. California Physicians' Service d/b/a Blue Shield of California, No. 24-6337 (9th Cir. Jan. 27, 2026; unpub.)  MORE >>

"[T]he Second Circuit ... [held] that the plan administrator did not act arbitrarily and capriciously in denying continued residential and partial hospitalization treatment for a dependent suffering from a severe eating disorder and related mental health conditions. The decision reinforces the breadth of deference afforded to administrators operating under a discretionary grant and sharply cabins efforts to use Wit v. United Behavioral Health to invalidate level-of-care guidelines outside the Ninth Circuit." [Savage v. Rabobank Med. Plan, No. 24-2759 (2d Cir. Feb. 5, 2026; unpub.]  MORE >>

"Pharmaceutical manufacturers weren't the only stakeholders cheering greater regulation for PBMs. Employers, which face enhanced fiduciary duties under the Consolidated Appropriations Act of 2021 (CAA), have also called for more oversight of the industry, especially as they're often kept in the dark about what their charges look like."  MORE >>

"From 2014 to 2023, prices for medical services rose by less than the overall rate of inflation. Increased enrollment has driven up Medicare costs (as baby boomers retire) and Medicaid costs (as eligibility expands). But the main factor behind higher insurance expenses has been greater utilization per enrollee, which has grown by roughly 20 percent across both public entitlements and private insurance."  MORE >>

"[The authors] summarize economic projections of moving to a single-payer health care system and look at how they compare with proposed federal cuts, based on analyses of the New York Health Act (NYHA) (A1466/S3425), a universal public health coverage bill in front of the New York State Legislature. [They] also outline how state plans such as the NYHA could avoid the need for federal waivers and explain why now is an especially important time for state-based reform."  MORE >>

"By expanding their allegations against ERISA plans, plaintiff firms unlocked the ability to sue individual plan sponsors, and sometimes individual plans, multiple times.... [O]ver a dozen companies ... faced multiple class ERISA lawsuits over the past two years, some by the same plaintiff firm. [This article provides an] analysis of ERISA litigation ... to highlight its unfairness to the plan sponsor community, and its impact on the fiduciary liability insurance market."  MORE >>