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 (the PCORI fee) is due by Friday, July 31, 2026. 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 Approaching

As GLP-1 medications become an increasingly significant cost driver for employer-sponsored health plans, plan sponsors are seeking creative solutions beyond conventional pharmacy benefit manager (PBM) channels. Direct-to-consumer reimbursement models have emerged as a compelling alternative, enabling participants to obtain these medications at reduced prices while shifting claims processing outside traditional PBM frameworks. Below, we outline the key legal and administrative considerations plan sponsors must address before adopting these arrangements.

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).

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.

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.

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.

We recognize that many companies sponsor ERISA welfare benefit plans and will soon be undergoing their open enrollment process and issuing related participant communications. To assist with that process, we have prepared an Automatic Participant Disclosures Checklist for use during open enrollment and throughout the plan year. Note that some of these disclosures may be delivered electronically under certain circumstances.

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.