The recent rise in state law regulation of pharmacy benefit managers (PBMs) and prescription drug pricing continues to test the limits of preemption under the Employee Retirement Income Security Act of 1974, as amended (ERISA).
Continue Reading ERISA Preemption – Alive and Well
Reminder: Group Health Plans Should Update HIPAA Notice of Privacy Practices by February 16
Many people see the start of a new year as a time to refresh and renew themselves. For covered entities under HIPAA, which include group health plans, it’s also time to refresh and renew your HIPAA Notice of Privacy Practices (Privacy Notice) to address the changes made to the Confidentiality of Substance Use Disorder (SUD) Patient Records regulations at 42 CFR part 2 (Part 2). The deadline for updating Privacy Notices to reflect these amendments is February 16, 2026.
Continue Reading Reminder: Group Health Plans Should Update HIPAA Notice of Privacy Practices by February 16What Trump’s Deal on GLP-1 Costs Could Mean for Employers
The high cost of GLP-1 weight loss drugs has significantly affected employer prescription drug spending over the past year, leading many organizations to limit or even eliminate coverage. These unexpected costs have created challenges for employers balancing plan affordability with employee access.
Continue Reading What Trump’s Deal on GLP-1 Costs Could Mean for EmployersNavigating the Evolving Landscape of State PBM Laws
The legal landscape for pharmacy benefit managers (PBMs) continues to shift as states pass new laws and courts weigh in on how those laws interact with federal ERISA requirements. These developments are creating new challenges for self-funded health plans trying to stay compliant.
Continue Reading Navigating the Evolving Landscape of State PBM LawsReminder – Annual Deadline (July 31) to Report and Pay PCORI Fee is Approaching
The annual filing (and fee payment) for applicable self-insured health plans and specified health insurance policies used to fund the Patient-Centered Outcomes Research Institute (PCORI fee) is due by Thursday, July 31, 2025. Internal Revenue Service (IRS) Form 720, Quarterly Federal Excise Tax Return, is used to report and pay (in Part II, IRS No. 133, on page 2) the annual PCORI fee.
Continue Reading Reminder – Annual Deadline (July 31) to Report and Pay PCORI Fee is ApproachingStuck in the Middle: Self-Funded Health Plans and Recent Challenges to State PBM Laws
In recent years, prescription drug prices have been top-of-mind for state legislators, who have responded by passing laws that seek to control that pricing in a variety of ways, including by regulating pharmacy benefit managers (PBMs).
Continue Reading Stuck in the Middle: Self-Funded Health Plans and Recent Challenges to State PBM LawsIRS Guidance Regarding ACA Employer Information Reporting Requirements
As announced in our previous HR Law Talk blog post, the Paperwork Burden Reduction Act (PBRA) made important changes to employers’ responsibilities to furnish information to employees under the Affordable Care Act (ACA). As part of the changes, employers may now provide “clear, conspicuous, and accessible” notice that individuals may request their Form 1095-B or 1095-C and distribute a Form 1095 only to individuals who request a copy, rather than furnish a Form 1095 annually to each covered individual. Recently, the Internal Revenue Service (IRS) released additional guidance for employers, with more details about satisfying the notice requirement.
Continue Reading IRS Guidance Regarding ACA Employer Information Reporting Requirements2025 Changes to ACA Employer Information Reporting Obligations and the Employer Shared Responsibility Penalties
In December 2024, Congress and President Biden passed two laws—the Paperwork Burden Reduction Act (PBRA) and the Employer Reporting Improvement Act (ERIA)—that made important changes to employers’ responsibilities regarding furnishing information to employees under the Affordable Care Act (ACA) information reporting provisions as well as the response deadlines and the statute of limitations for the employer shared responsibility penalty assessments.
Continue Reading 2025 Changes to ACA Employer Information Reporting Obligations and the Employer Shared Responsibility PenaltiesBREAKING: DOL Expands the Voluntary Fiduciary Correction Program
Earlier today, the U.S. Department of Labor (DOL) published in the Federal Register an updated version of the Voluntary Fiduciary Correction Program (VFCP) under Title I of ERISA. Per the DOL, VFCP “is designed to encourage correction of fiduciary breaches and compliance with law by permitted persons to avoid potential [DOL] civil enforcement actions and civil penalties if they voluntarily correct” errors in accordance with the program. Notably, the update expands the current VFCP by adding a much-anticipated self-correction component for delinquent transmittal of participant contributions and loan repayments to retirement plans in specific circumstances.
Continue Reading BREAKING: DOL Expands the Voluntary Fiduciary Correction ProgramStatus of PBM Regulation in the States
I recently authored an article for BenefitsPRO examining the status of pharmacy benefit manager (PBM) regulation in the states. While benefits professionals have seen the cost of prescription drugs rise, there is a lack of consensus as to what exactly is causing the increase. As PBMs serve as the intermediary between prescription drug manufacturers and insurance or benefit providers to help providers save on prescription drugs, PBMs have found themselves under increased scrutiny and the target of litigation and heightened regulation.
Continue Reading Status of PBM Regulation in the States