"Sponsors of HRAs and other account-based plans, which are typically offered alongside major medical plans, will welcome the relief from providing burdensome and potentially confusing Part D creditable coverage notices. Sponsors of plans that remain subject to the disclosure requirements should use the 2027 parameters when determining whether their plans' prescription drug coverage is creditable for that year."  MORE >>

"If finalized, the proposed regulations could significantly alter how employer health plans evaluate PBM arrangements.... Plan fiduciaries would have greater access to data necessary to assess whether PBM compensation is reasonable and whether PBM arrangements present conflicts of interest.... The new disclosure regime may affect contract negotiations, particularly regarding rebate pass-through structures, spread pricing arrangements, and audit rights and reporting obligations.... Greater transparency could increase litigation risk where PBM compensation appears excessive or inconsistent with fiduciary duties under ERISA."  MORE >>

"McKee confirms that there are limits to state PBM regulation. States may regulate PBM reimbursement rates and other costs, but when they: Require inclusion of all willing pharmacies in networks, or Prohibit differential copays and other steering mechanisms within networks, they are dictating ERISA plan structure and administration and risk preemption, at least as applied to self‑funded plans." [McKee Foods Corporation v. BFP Inc., No. 25-5416 (6th Cir. Apr. 7, 2026)]  MORE >>

" This settlement highlights the ongoing legal risks for plan sponsors and insurers that maintain broad exclusions for items or services closely associated with a disability. Although the settlement is not an admission of wrongdoing, it underscores that even seemingly neutral plan terms can be challenged as discriminatory under ACA Section 1557. Plan sponsors should review their plan documents for exclusions that may have a disproportionate impact on individuals with disabilities and consider the potential for proxy discrimination claims"  MORE >>

"Employers don't lower healthcare costs by shifting them -- they lower costs by shaping how decisions get made. Healthcare costs will always be influenced by factors outside any single employer's control. But employers have more influence than they think, especially when they treat health benefits like a product for their employees and apply the same discipline they do to other major spends."  MORE >>

"This year, 37% of the PBGH's members have issued a 'request for proposals' for medical benefits, meaning they're shopping between insurance providers. The last time the PBGH surveyed its members on this issue, in 2024, just 12% of employers were conducting a medical RFP."  MORE >>

"[M]ost privately insured adults believed GLP-1 medications should be covered by health insurance, indicating broad support for coverage of these treatments among consumers. However, one-half did not know if they were covered by their plan. Among those who said they were covered, one-third reported that they were only covered for diabetes, one in 10 reported that they were only covered for obesity, and four in 10 reported that they were covered for both."  MORE >>

"Insurers hoping for a reprieve from an out-of-network billing system largely favoring healthcare providers will likely be left wanting as federal policymakers sit on their hands and one large payer's bid to limit the claims faces an uphill battle, strategy firm Capstone concluded in a new report. A quarter-by-quarter rise in total payment dispute volumes is likely to continue due to the structural incentives for providers to engage in the process ... Such a trend would be slightly positive for hospitals, solidly beneficial for specialty providers and a roadblock for payers -- 'however, employers could face an additional burden,' they said."  MORE >>

"Variable copay plans are some of the fastest growing commercial offerings by carriers. Metrics from insurance carriers show that members enrolled in these plans have cut their out-of-pocket costs by upwards of 50%, and that employers can achieve an estimated 7-12% savings. That’s a meaningful opportunity to improve health care affordability."  MORE >>

"Trump Accounts are a new form of traditional individual retirement account (IRA) that the 2025 reconciliation law (P.L. 119-21) created for the benefit of children. Savers will be able to contribute to Trump Accounts starting on July 4, 2026.... Anyone can contribute to a child's Trump Account, although individual contributions during the growth period are not tax-deductible for either the contributor or the beneficiary. Employers can contribute up to $2,500 (adjusted for inflation after 2027) tax-free to the Trump Accounts of employees or their dependents (amount is per employee, per year)."  MORE >>

"Aronowitz testified that fiduciaries are 'paralyzed with very rational fears' about litigation, and this 'stifles innovation in plan design' to the detriment of plan participants. Many of these lawsuits amount to 'unfair, hindsight second guessing,' he argued. He added that many fiduciary meetings focus on avoiding litigation rather than helping their participants."  MORE >>