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New California PBM Law Takes Effect in 2026

"Provisions that relate specifically to PBM business practices generally take effect on January 1, 2026, while those that will impact fully insured plans take effect on contracts issued, amended, or renewed on or after January 1, 2026.... [T]he law contains an express exemption to PBMs when providing services to self-insured multiemployer union (Taft Hartley) plans subject to ERISA."

Post Annual Enrollment Check-In: New Vendors

"[P]lan sponsors often make changes year to year, and those changes require additional administrative action on the sponsor's part.... For group health plans, it includes obligating those vendors to comply with HIPAA, ACA, and transparency. Before you sign the contract, ensure that the important compliance requirements a plan cannot perform alone are considered in the contract. And, at the end of the process, do not forget to amend internal documents and policies, as needed, to reflect the changes."

Reminder: Gag Clause Prohibition Compliance Attestation Changes in 2025

"Fourth quarter compliance activities have included the gag clause prohibition compliance attestation for the third year in a row. This year, there are important changes ... including the requirement to confirm the absence of gag clauses in your insurer or third party administrator's downstream agreements with other third parties, such as their network providers. The attestation is due by December 31. "

DOL Restarts Self-Audit Program for FLSA and FMLA Violations

"Affected employees identified in the self-reported claim will be provided with a PAID Acceptance Letter outlining the violations and the back wages or remedies owed. If the affected employee accepts the settlement terms, they will forfeit their right to further litigation for the specific violations outlined in the letter.... Employees do not have to accept the settlement and can retain their right to civil litigation for the identified violations."

A Balancing Act: State PBM Laws and ERISA Preemption (PDF)

"For now, we know that Rutledge does not preempt PBM regulations that merely increase the cost of doing business in the state. Mulready preempts plan design requirements, including network adequacy, in PBM laws in the 10th Circuit, but network considerations are likely not preempted pursuant to Wehbi in the 8th Circuit. Finally, Gobeille provides an argument that ongoing reporting and attestations are preempted.... [T]he only thing that is clear is that PBM laws that merely increase plan costs, without more, are not preempted. Most other types of provisions ... are still up for debate."

Preparing for 2025: Creditable Coverage Changes and Medicare-Eligible Employees

"It will be more difficult for HDHP prescription drug coverage to be considered creditable coverage. Other plans with high deductibles will also be impacted.... Medicare-eligible employees that do not enroll in Medicare Part D during their initial enrollment period and fail to maintain creditable coverage will incur a late enrollment penalty if the gap is 63 days or more."

The Conundrum of the Sickest Participants

"[W]hat if the employee would be better off without your plan? What if finding them other funding sources results in a win-win for all involved? The unfortunate answer is that there is no simple way to simultaneously help the participant and move them off the plan. [This article discusses] some popular ideas and the compliance risks that arise from them."

Dos and Don’ts for ERISA Document Requests

"[1] Don't ignore it.... [2] Do ask for help.... [3] Don't overshare.... [4] Do reflect and correct."

Implementing the 2023 Form 5500 Changes

"The updated form contains some significant changes for certain retirement plans and is effective for plan years beginning on or after January 1, 2023.... [1] Determining small or large plan status ... [2] Breakdown of administrative expenses ... [3] Consolidation rules for Defined Contribution Groups (DCGs) ... [4] Internal Revenue Code compliance questions ... [5] New disclosures for Multiple Employer Plans (MEPs) ... [6] Electronic filing for the extension of time to file."

Final Medicare Part D Instructions Spare the Simplified Creditable Coverage Determination Method

"[T]he Final Instructions ... kept the simplified methodology, without modification, as an alternative to the actuarial value test for 2025 for plans not seeking the RDS.... [E]mployers need to be prepared for modifications or a completely new 'simplified' method for 2026 and beyond.... Plan sponsors, particularly calendar year plans, should begin analysis ... to see what, if any, changes need to occur for their 2025 prescription drug plans."