"Pharmacy Benefit Manager (PBM) arrangements have long relied on rebates with limited transparency into true drug costs. Recent regulatory and market developments represent a shift toward greater transparency and better net pricing. These developments span a broad range of actors and approaches, including increased regulation of PBMs by the states, legislative, rule-making and agency actions by the federal government, and evolving market-driven responses. This post provides a high‑level overview of key developments and offers practical steps for health plan fiduciaries to consider[.]"  MORE >>

"[T]he Western District of Kentucky addressed two post-remand disputes in a long-term disability benefits case: whether Plaintiff's motion to reopen was prematurely filed and whether Plaintiff was entitled to attorney's fees following a court-ordered remand that the insurer had initiated. The court denied the motion to reopen, denied attorney's fees, and awarded costs only." [Chalk v. Life Ins. Co. of N. Am., No. 25-0133 (W.D. Ky. May 7, 2026)]  MORE >>

"As federal and state governments continue to prioritize drug pricing reform, employers across the nation face a rapidly evolving landscape of legal and regulatory scrutiny regarding the management of their health plans. A convergence of class action ERISA litigation, inquiries from a coalition of 14 states, and increased federal emphasis on health care price transparency has created new compliance challenges and potential areas of risk for plan fiduciaries. Ongoing developments shed light on the implications for employers and compliance considerations for their health plans as related to health care and prescription drug management."  MORE >>

"[This article] examines the unsettled and contested landscape of AI regulation ... It explains how the growing use of AI in group health plans intersects with existing federal laws ... particularly HIPAA ... The discussion highlights unresolved questions about whether training AI on claims data qualifies as permissible healthcare operations and ... further analyzes mental health parity compliance ... The rise of AI and its application to the maintenance and operation of group health plans raises the fiduciary bar exponentially higher."  MORE >>

"Thirteen new drugs and one gene therapy have already received FDA approval in 2026, ... New oral GLP-1s are entering the market, changing usage patterns -- especially for weight loss treatment.... Patents are expiring for several key brand specialty and non-specialty drugs, clearing the way for new generic and biosimilar options in 2026.... Changes in the market are supporting list price reductions, a shift from rebates and to more aggressive price competition."  MORE >>

24 pages. "[W]ith few truly competitive hospital markets left in the country, most of our nation's families get their care through large corporate hospital systems that charge nearly three times more for hospital care than what Medicare pays for the same services. These corporate health systems are charging excessive prices and raking in tens of millions of dollars each year, while patients and families struggle to pay their medical bills."  MORE >>

"These tariffs are aimed at pharmaceutical manufacturers, not employers.... Any impact on employer-sponsored health plans will depend on how manufacturers respond and how pharmacy benefit managers, or PBMs, translate those decisions into pricing, rebates, coverage decisions, and reporting. For many employers, this may not result in any meaningful near-term change. The main value right now is understanding whether your plan relies heavily on the kinds of drugs most likely to be affected."  MORE >>

"Employers rate mental health support among the highest impact benefits they can offer, and employees increasingly see mental and emotional well-being as fundamental to how they show up at work and engage with their benefits.... [O]ff-exchange plans and [ICHRAs] have effectively standardized mental health coverage. Parity has moved from intent to execution. Employers are being asked to show that mental health support is meaningfully accessible -- not just technically covered."  MORE >>

"On April 15, 2026, the Department of Treasury announced 5 million Accounts had been opened.... Employers should also expect employees to ask whether they will be offering Account contributions as an employee benefit.Employers should be prepared to answer whether employees can contribute through their cafeteria plans.... Employers should also expect employees to ask whether they will be offering Account contributions as an employee benefit."  MORE >>