News & Analysis as of

Employer Group Health Plans Pharmacy Benefit Manager (PBM)

Bricker Graydon LLP

Is My Group Health Plan Covered by State PBM Reporting Laws?

Bricker Graydon LLP on

State laws seeking to regulate pharmacy benefit managers (PBMs) have increased significantly over the past few years. As it stands, all 50 states have laws that regulate PBMs in some way, but all are unique. However, most of...more

Seyfarth Shaw LLP

Cutting Out the Middle Man

Seyfarth Shaw LLP on

Arkansas has become the first state in the nation to enact legislation, effective starting in 2026, prohibiting pharmacy benefit managers (PBM’s) from owning or operating actual pharmacies within the state. We take a look at...more

Lathrop GPM

Call for Additional Regulations for Health Plan Compensation Disclosures

Lathrop GPM on

In an April 15 Executive Order, entitled “Lowering Drug Prices by Once Again Putting Americans First,” the Trump Administration has called attention to an ERISA disclosure required by the Consolidated Appropriations Act of...more

McAfee & Taft

Challenge to copay assistance strategy, another PBM ERISA preemption lawsuit, and other compliance issues for 2025

McAfee & Taft on

The end of 2024 gave group health plan sponsors several new lawsuits to watch in 2025. Gurwitch v. SAVE ON SP LLC - On December 26, 2024, a class action complaint was filed in the U.S. District Court for the Northern District...more

Alston & Bird

2024 Health Benefits Year: A Year to Remember

Alston & Bird on

The year was packed with developments for health and welfare benefits plans. Our Health Benefits Team reviews 2024, from new data privacy rules to disaster tax relief....more

Wiley Rein LLP

PBM Contracting and Administration: What Are the Rules of the Road for Self-Insured Employees?

Wiley Rein LLP on

In February 2024, a group representing (among others) the Johnson & Johnson Group Health Plan and its component plans (Plaintiffs) sued Johnson & Johnson and The Pension & Benefits Committee of Johnson and Johnson (J&J) over...more

Jackson Lewis P.C.

Health Plan Hygiene Part 4 – Show Me the Money

Jackson Lewis P.C. on

Our “health plan hygiene” series has focused on steps that fiduciaries of employer-sponsored group health plans can take to ensure they meet their fiduciary responsibilities. This issue has been brought to the forefront...more

Mayer Brown

United States: Health and Welfare Hot Topics

Mayer Brown on

At A Glance - In recent months, there have been a number of important developments in the United States relating to health and welfare plans. This list of hot topics identifies the key areas for employers and plan sponsors to...more

Holland & Hart - The Benefits Dial

Hole in the Bottle… Employer Considerations After Another Lawsuit Against an Employer Health Plan

Last week, former Wells Fargo employees filed a class action lawsuit against Wells Fargo and its health plan fiduciaries alleging that Wells Fargo’s self-funded health plan violated ERISA by paying its pharmacy benefits...more

Groom Law Group, Chartered

ERISA Group Health Plans – The New Target in Fee Cases

Earlier this year, a Johnson & Johnson (“J&J”) employee brought a class action complaint (the “Complaint”) against J&J alleging fiduciary breaches under ERISA related to the prescription drug coverage under J&J’s self-funded...more

Verrill

RxDC Reporting in Light of June 1, 2024 Deadline and Recent PBM Litigation

Verrill on

Under the Consolidated Appropriations Act of 2021 (“CAA”), employer-sponsored group health plans, including medical-only plans, must submit information about their prescription drugs and health care spending. This submission...more

Jones Day

Fiduciaries Beware: Employer Health Plan Under Fire for Alleged Prescription Drug Mismanagement

Jones Day on

An employer health plan is the latest target of class action litigation seeking redress for the alleged conduct of the plan's pharmacy benefit manager ("PBM")....more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Florida PBM Law Limits Mail-Order Prescription Drug Programs, Requires State Filings by Employer Plans

Employers that cover Florida employees under their prescription drug plans are now prohibited from imposing mandatory mail-order requirements and are required to provide a sixty-day continuity of care period following midyear...more

McAfee & Taft

Employee benefit rules: The gifts that keep on giving

McAfee & Taft on

As employers look back at 2023 and ahead to 2024, there are so many compliance-related items to consider relating to their employee benefit plans.  The rules employers are supposed to be complying with keep growing and...more

Alston & Bird

Year-End Health Benefits Roundup 2023

Alston & Bird on

It was a lively year for health benefits. Our Employee Benefits & Executive Compensation Group unpacks 2023, from the end of the COVID-19 emergencies to the much-anticipated Mental Health Parity and Addiction Equity Act...more

Snell & Wilmer

2023 End-of-Year Plan Sponsor “To Do” Lists (Part 1) Health and Welfare

Snell & Wilmer on

We are pleased to present our annual End of Year Plan Sponsor “To Do” Lists. This year, we present our “To Do” Lists in four separate Employee Benefits Updates. This Part 1 covers year-end health and welfare plan issues....more

Bass, Berry & Sims PLC

Tenth Circuit Rules ERISA Preempts Oklahoma PBM-Reform Law

Bass, Berry & Sims PLC on

In a win for self-funded (i.e., self-insured) health plans subject to the Employee Retirement Income Security Act of 1974, as amended (ERISA), the Tenth Circuit recently ruled that ERISA preempts provisions of an Oklahoma law...more

Foley Hoag LLP

10th Circuit Invalidates Oklahoma Pharmacy Network Law as Applied to ERISA and Medicare Part D Plans

Foley Hoag LLP on

The U.S. Court of Appeals for the 10th Circuit issued a sweeping decision that (1) maintains long-standing federal protections for employer and union-sponsored health plans to design their health benefit plans, including...more

McDermott Will & Emery

Tenth Circuit Reaffirms Preemption of State Pharmacy Network Regulations

McDermott Will & Emery on

The US Court of Appeals for the Tenth Circuit recently held in Pharmaceutical Care Management Association (PCMA) v. Mulready that the Employee Retirement Income Security Act (ERISA) and Medicare Part D preempted several...more

Snell & Wilmer

Five Facts About the Annual Gag Clause Prohibition Compliance Attestation

Snell & Wilmer on

Effective December 27, 2020, the Consolidated Appropriations Act, 2021 (“CAA”), as part of its transparency in health care protections, prohibits group health plans and issuers from entering into agreements that directly or...more

Mintz - Health Care Viewpoints

Senate HELP Committee Eyes Drug Pricing and PBM Regulation Beyond Federal Programs

On April 25, 2023, the Senate Health, Education, Labor, and Pensions Committee Chairman Bernie Sanders and Ranking Member Bill Cassidy introduced a package of legislation aimed at lowering prescription drug prices. The...more

Foley & Lardner LLP

Key Considerations When Offering Abortion Coverage Under a Group Health Plan

Foley & Lardner LLP on

Not surprisingly, leading up to and in the wake of the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, our employee benefits team has been spending a lot of time helping our clients wade through...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Medical Travel Reimbursement Benefits Under the Supreme Court’s New Dobbs Decision

On June 24, 2022, the Supreme Court of the United States issued its highly anticipated decision in Dobbs v. Jackson Women’s Health Organization, No. 19-1392. The Dobbs decision expressly overrules the two key precedents that...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Making a List, Checking It Twice: Year-End Guidance on Drug Cost Reporting

Employers and their benefit administrators have more detail and a more convenient way to submit “top 50” lists and other data - but no more time to comply with - daunting prescription drug cost reporting requirements in the...more

Mintz - Employment Viewpoints

Supreme Court Holds that ERISA Does Not Preempt Arkansas PBM Law: The Impact on Employer Sponsored Group Health Plans

In a recently decided case, Rutledge v. Pharmaceutical Care Management Association, the U.S. Supreme Court held that the Employee Retirement Income Security Act of 1974 (ERISA) does not preempt an Arkansas statute that...more

31 Results
 / 
View per page
Page: of 2

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide