"This software is being issued only as a supplemental tool for issuers of risk adjustment covered plans to better understand and simulate the calculation of plan liability risk scores for their enrollees.... Python software is being phased in to replace the SAS software, which will be discontinued for benefit year 2026." Also available:

• Technical Details (XLSX) 
• 2025 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP)
• 2025 Benefit Year Risk Adjustment: Python Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP)

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"The deadline to file the 2025 Forms 1094-C and 1095-C for filers is today, March 31, 2026.... [T]he employer may receive an automatic 30 day extension by filing a Form 8809 with the IRS. This extends the electronic deadline to April 30, 2026. This article provides basic instructions regarding how an employer should complete the Form 8809."  MORE >>

"The Federal Trade Commission (FTC) reached an agreement with Express Scripts that requires the [PBM] to offer a new, more transparent, net‑price‑based pharmacy option. This mandate isn't universal, as it doesn't require the PBM to apply these economics across all clients.... The settlement sets a new regulatory floor -- not a full market overhaul -- but it gives employers a compliant, more transparent alternative."  MORE >>

"For years, voluntary or enhanced benefits were treated as the safest part of the benefits package with minimal risk, explains Eric Silverman, founder of Voluntary Disruption. He says ERISA lawsuits involving accident, critical illness, cancer and hospital indemnity plans have forced a closer look at how these benefits are selected, priced, monitored and communicated. And the key takeaway is that process matters, even when benefits are not employer-funded."  MORE >>

"In 2024, the United States had an estimated population of 335 million individuals. Most of those individuals had private health insurance or were covered under a federal program (such as Medicare or Medicaid). About 8.2% of the U.S. population was uninsured. Individuals (including those who were uninsured), health insurers, and federal and state governments spent approximately $5.0 trillion on various types of health consumption expenditures (HCE) in 2024, which accounted for 17.2% of the nation's gross domestic product." [IF10830 updated Mar. 31, 2026]  MORE >>

"This analysis examines antidepressant and anxiolytic medication prescribing across provider types at a national and state level from 2018-2022 among people with Employer Sponsored Insurance (ESI).... [M]ost antidepressant and anxiolytic prescriptions for people with ESI are prescribed by [primary care providers (PCPs)], with some variation in prescribing patterns by state. This finding is consistent with previous research that found most psychotropic medications are prescribed by general practitioners. More research is needed to understand the implications of high levels of PCP prescribing."  MORE >>

"Most U.S. adults take at least one prescription drug ... Six in ten adults say they are worried about being able to afford their prescription drug costs, a new high since KFF began asking in 2018.... Increasing use of GLP-1 medications raises particular cost concerns.... About one in five adults have ever taken a GLP-1 medication, and most users -- including those with health insurance -- say these drugs are difficult to afford."  MORE >>

"Transparency requires eliminating spread pricing ... Net cost must reflect actual cost -- not estimates ... Transparency must be backed by verifiable performance guarantees ... Outcomes -- not benchmark pricing -- should define value ... Transparency reshapes how rebates influence plan design strategy ... Transparency reframes the narrative around clinical management."   MORE >>

"When you look at what UnitedHealthcare actually pays for basic office visits, the numbers are all over the map. There is no rhyme or reason to it. There is no market rate. There is only the price that a specific doctor was able to negotiate on a specific day.... If you are an employer providing health insurance, this lack of discipline is costing you a fortune. You are handing your credit card to a middleman who has no incentive to find the best price."  MORE >>

"It remains to be seen what level of 'buy-in' will occur from individuals and employers. The initial funding of new accounts under the Treasury's pilot program might encourage parents to establish a Trump Account for their children to at least seed the accounts with those contributions. Trump Accounts also might be used as a wealth-transfer vehicle if parents and grandparents make contributions on behalf of their children and grandchildren."  MORE >>