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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

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…

In April 2024, the Department of Health and Human Services (HHS) finalized revised regulations implementing Section 1557 of the Patient Protection and Affordable Care Act (ACA). The new, final Section 1557 regulations (2024 Rule) have staggered effective dates—beginning as early as November 2, 2024—and the 2024 Rule now applies to recipients of Medicare Part…

In an article for HR.com’s Employee Benefits & Wellness Excellence issue, we highlighted key issues to watch in benefits law for the remainder of 2024. Among the top three of these considerations for the rest of the year, we listed retirement plan regulations from SECURE 2.0, litigation surrounding pharmacy benefit managers (PBM), and welfare plan compensation disclosures and associated litigation.Continue Reading Hot Issues for Second Half of 2024

On June 28, 2024, the Supreme Court issued its opinion in Loper Bright Enterprises v. Raimondo, Secretary of Commerce and Relentless, Inc. v. Department of Commerce (Loper Bright), overturning Chevron U.S.A. Inc v. Natural Resources Defense Council, Inc. (Chevron). In this landmark case, Loper Bright overruled the forty-year doctrine known as “Chevron deference,” whereby courts defer to an administrative agency’s reasonable interpretation of ambiguous federal laws, even if the court disagrees with the agency’s interpretation. Instead, Loper Bright held that courts must exercise independent judgment in deciding whether an administrative agency has acted within its statutory authority, and may not automatically defer to an agency’s legal interpretation when a statute is ambiguous.Continue Reading Chevron No More: The Impact on Benefit Plans

In the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization and subsequent state abortion bans, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services issued a Final Rule (Final Rule) modifying the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule in order to support reproductive health care privacy. As with prior HIPAA rules, the Final Rule applies to covered healthcare providers, health plans, or healthcare clearing houses (each, a Covered Entity) and their business associates.Continue Reading New Reproductive Health Care Privacy Final Rule: Key Compliance Steps and Dates

The U.S. Department of Labor issued final regulations on April 23, expanding the definition of “fiduciary” under ERISA. The final regulations alter the definition of “investment advice fiduciary” for purposes of Title I and Title II of ERISA to impose fiduciary duties on individuals or entities that make compensated recommendations related to the use of retirement assets to participants, beneficiaries and owners of qualified retirement plans and IRAs.Continue Reading BREAKING: DOL Expands Definition of Fiduciary under ERISA

As mentioned in our recent blog post, the recently filed class action lawsuit against Johnson & Johnson (Lewandowski v. Johnson & Johnson et. al., D.N.J., No. 1:24-cv-00671 (Feb. 5, 2024)) over alleged excessive prescription drug costs takes a new approach with respect to familiar claims of breach of fiduciary duty for failure to monitor plan costs. Instead of targeting retirement plan fiduciaries, who have been a common target of excessive fee litigation over the last several years, the Lewandowski plaintiffs take aim at the actions of welfare plan fiduciaries.Continue Reading Welfare Plan Class Action Litigation Underscores Importance of Minding Your Fiduciary Duties

While the sweltering roil of temporary regulatory changes related to the COVID-19 pandemic may have cooled and the initial burst of SECURE 2.0 steam begins to dissipate, sponsors of employee benefit plans should keep their eyes on several hot button issues during the remainder of 2024 as these issues continue to percolate.Continue Reading Caution! Contents Hot: Key Benefits Issues to Watch During the Remainder of 2024

From the Bass, Berry & Sims Blog Network
From the Bass, Berry & Sims Blog Network

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