"Sponsors of self-insured group health plans should review existing contractual arrangements with consultants, third party administrators and pharmacy benefit managers. If the proposed regulation is finalized, these new requirements are effective for plan years beginning on or after July 1, 2026."  MORE >>

"Employers that sponsor a group health plan should review existing contractual arrangements with pharmacy benefit managers or other entities that provide pharmacy benefit management services to ensure that these new requirements are reflected in the agreement. It is expected that agreements will have to be amended for plan years beginning on or after August 3, 2028, for these new rules."  MORE >>

"This Alert provides an overview of three key developments in the PBM reform landscape and offers a deeper analysis of ... the [DOL's] proposed rule, which is open for public comment until March 31, 2026."  MORE >>

"February 16, 2026 was not just another regulatory waypoint -- it marked the compliance deadline for significant changes affecting [HIPAA] Notices of Privacy Practices (NPP), driven by amendments aligning HIPAA more closely with ... the federal confidentiality regulations for substance use disorder (SUD) records. If your plan has not recalibrated yet, now is the time to check your settings."  MORE >>

"February 22 is a deadline to beat.... [R]eview and update your policies, train your supervisors, and ensure your payroll systems are ready. The amendments are complex, the effective date is imminent and DCWP will be watching."  MORE >>

"Are employer-sponsored health plans required to cover GLP-1s for weight loss? ... Do any state insurance laws mandate coverage of GLP-1 drugs for weight loss? ... How common is it for employer-sponsored plans to cover GLP-1 drug for weight loss? ... When such coverage is offered, is it common to impose conditions to qualify for it? ... May an employer-sponsored health plan offer indication-based coverage for GLP-1 medications? ... Are there alternative ways to support employees who seek weight loss medications?"  MORE >>

"CGT users represent fewer than 0.1% of the enrollee population but account for approximately 0.5% of total spending. This includes both the cost of CGTs and spending on other health services.... Impact on High-Cost Claimants: Among enrollees in the top 1% of total health care spenders, just 0.58% used CGTs. However, these individuals accounted for 1.6% of spending within that top spending group. While the share is small, it signals that CGTs can meaningfully impact spending patterns among high-cost claimants."  MORE >>

"EmblemHealth will compensate customers who paid out of pocket for mental health care because they couldn't secure an appointment with a provider listed as being in-network. It also pledged to take additional steps to fix its provider directory."  MORE >>

"The average plan could pay for approximately one year and four months of benefits and expenses with its net assets, an increase of approximately one-and-a-half months of total expenses from last year.... On a per member basis, expenses increased by 5.8% and total contribution income increased by 3.2% year over year. Over 80% of plans had a net gain in 2023, a significant improvement compared to both 2021 and 2022, when plan income was greater than expenses for about half of plans."  MORE >>

"This third report extends trends in claims data in this series into 2022, the first year post-NSA implementation.... In 2023, providers won around 80% of IDR determinations over OON claims and around 85% of IDR determinations over OON air ambulance services. This report also includes an analysis of trends in consolidation in health care markets, though it does not attempt to estimate specific effects of the NSA."  MORE >>