News & Analysis as of

Prescription Drugs Employee Benefits Health Insurance

Eversheds Sutherland (US) LLP

Benefits Catch-Up - Q2 2025

With so much happening in the employee benefits world over the last few months, we bring you Benefits Catch-Up, our catch-up contribution to help you keep up with recent developments. Eversheds Sutherland’s US Employee...more

Troutman Pepper Locke

Navigating Legal Strategies for Covering GLP-1s in Self-Insured Medical Plans — Employee Benefits and Executive Compensation...

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In this episode of Troutman Pepper Locke's Employee Benefits and Executive Compensation podcast, hosts Lydia Parker and Lynne Wakefield explore the complex legal landscape surrounding the coverage of GLP-1s prescribed for...more

Venable LLP

June 1, 2025 Prescription Drug Reporting Deadline for Group Health Plans

Venable LLP on

Employer group health plans must make an annual disclosure of the plan's prescription drug and healthcare spending to the Centers for Medicare & Medicaid Services (CMS). The disclosure, called the Prescription Drug Data...more

Seyfarth Shaw LLP

Cutting Out the Middle Man

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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

Maynard Nexsen

JPMorgan Sued Over Management of Prescription Drug Benefits

Maynard Nexsen on

On March 13, 2025, several current and former participants in the JPMorgan Chase Health Care and Insurance Program for Active Employees, as well as its component Medical Plan (collectively referred to as the “Plan”) filed a...more

Holland & Knight LLP

Excessive Fee Cases: Not Just for Retirement Plans Anymore

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A recent wave of cases has attempted to apply the theory of liability for retirement plan excessive fee cases to health plans – specifically, arrangements with pharmacy benefit managers. Though the cases thus far have...more

Groom Law Group, Chartered

Plaintiffs Double Down on Challenges to PBM Arrangements in Class Action Lawsuits Involving Johnson & Johnson and JPMorganChase

On March 10, 2024, the plaintiffs filed an amended complaint in a much-followed putative class action lawsuit against Johnson & Johnson (“J&J”) alleging that the plan fiduciaries for J&J’s group health plan violated ERISA by...more

Verrill

The GLP-1 Coverage Conundrum: Managing Costs for Group Health Plans

Verrill on

Many employers are facing challenges in incorporating high-cost GLP-1 medications, such as Mounjaro, Ozempic, Rybelsus, Trulicity, and Wegovy, into their group health plans, as they must balance the cost to the group health...more

Woodruff Sawyer

Reminder: RxDC Reporting Due June 1st

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With the 2024 reference year RxDC reporting deadline approaching in June, plan sponsors should re-familiarize themselves with the reporting requirements. The 2024 reference year RxDC Reporting Instructions have been released,...more

Alston & Bird

Final Mental Health Parity Rules: A Plan Sponsor’s Implementation Guide

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Our Employee Benefits & Executive Compensation Group discusses what health plan sponsors need to know about the final rule on nonquantitative treatment limitations (NQTLs) and NQTL comparative analysis under the Mental Health...more

Groom Law Group, Chartered

Third Circuit Affirms Dismissal of ERISA Claims Based on Employer’s Retention of Prescription Drug Rebates

On September 25, 2024, the United States Court of Appeals for the Third Circuit affirmed the dismissal of a putative class action lawsuit alleging that an employer violated ERISA by retaining approximately $65 million in...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

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

Bass, Berry & Sims PLC

Caution! Contents Hot: Key Benefits Issues to Watch During the Remainder of 2024

Bass, Berry & Sims PLC on

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...more

Polsinelli

Florida Legislative Session 2024: Health Care Highlights

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The Florida Regular Legislative Session began on January 9, 2024, and ended on March 8, 2024. Below is a summary of relevant health care laws that will be effective July 1, 2024, if they are approved by Governor DeSantis....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

Seyfarth Shaw LLP

Drugmaker Sued for…Overpaying for Drugs? Lawsuit Ushers in Expected Wave of Welfare Fiduciary Litigation

Seyfarth Shaw LLP on

The first complaint was filed in what is expected to be a wave of litigation alleging breach of fiduciary duty in selecting and monitoring welfare plan vendors. While the facts of this particular case may make it somewhat...more

Ballard Spahr LLP

HHS Announces Temporary Copay Accumulator Non-Enforcement Policy

Ballard Spahr LLP on

The United States Department of Health and Human Services (HHS) has filed court pleadings stating that it does not intend to initiate enforcement actions against plans that maintain copay accumulator programs....more

Ballard Spahr LLP

Prescription for Chaos: Copay Accumulator Programs Called Into Question

Ballard Spahr LLP on

Summary - Employers taking advantage of copay accumulator programs now face unexpected administrative complications following a recent federal court decision....more

Stinson - Benefits Notes Blog

Departments Provide Relief for 2020 and 2021 Prescription Drug Reporting

On December 23, 2022, the Departments of Labor, Health and Human Services and Treasury (the “Departments”) issued FAQs providing relief from prescription drug and health care spending reporting requirements. The FAQs are...more

Woodruff Sawyer

Compliance Alert: Agencies Extend RxDC Reporting Deadline to January 31, 2023

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On December 23, 2022, federal agencies released ACA and CAA Implementation FAQ Part 56, which extends the December 27, 2022 deadline for Prescription Drug Data Collection Reporting (“RxDC Reporting”) through January 31, 2023,...more

FordHarrison

Deadline for Prescription Drug and Health Care Spending Reporting

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The Consolidated Appropriations Act (CAA) adopted a new prescription drug reporting mandate on November 12, 2021. The mandate requires group health plans and group health insurers to submit prescription drug and health care...more

Venable LLP

REMINDER: October 15 Is the Deadline for Prescription Drug Notices and the Extended Deadline for Form 5500s

Venable LLP on

Does your company's health plan provide prescription drug coverage? If so, you have until October 15, 2022 to send a notice to individuals who are enrolled in Medicare Part A or Part B and are eligible for the company's...more

ArentFox Schiff

As It Mulls Whether To Grant Cert in ERISA Case on PBM Fiduciary Liability, Supreme Court Seeks Government's Input

ArentFox Schiff on

In December, the Supreme Court requested that U.S. Solicitor General Elizabeth Prelogar file a brief in John Doe 1 v. Express Scripts Inc., weighing in on whether the Court should hear a case about prescription drug costs. If...more

Williams Mullen

PODCAST: Williams Mullen's Benefits Companion - New Prescription Drug and Health Coverage Reporting Requirements

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On this episode of Williams Mullen's Benefits Companion, host Brydon DeWitt discusses the Biden administration’s interim final rule that requires health plans to report prescription drug and health coverage costs and its...more

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