Employee Benefits Archives - EMPLOYEE BENEFITS BLOG

New EO Targets Prescription Drug Costs – and Drug Manufacturers, Hospitals, and Health Centers

by Emily J. Cook, Michael Ryan and Sydney Merritt Martinez | May 15, 2025 | Employee Benefits, Health and Welfare Plans

On April 15, 2025, President Trump signed an executive order (EO) aimed at addressing the cost of prescription drugs. This EO, titled “Lowering Drug Prices by Once Again Putting Americans First,” outlines specific directives designed to reduce drug prices and improve access for US patients. Of particular note for sponsors and providers of employer health plans, the EO tasks the US secretary of labor with proposing regulations to improve employer health plan fiduciary transparency into direct and indirect compensation received by pharmacy benefit managers.

Read more here.

IRS Announces 2026 Limits for Health Savings Accounts, High-Deductible Health Plans, and Excepted Benefit HRAs

by Jacob Mattinson and Sarah Raaii | May 6, 2025 | Employee Benefits, Health and Welfare Plans

The Internal Revenue Service recently announced cost-of-living adjustments to the applicable dollar limits for health savings accounts, high-deductible health plans, and excepted benefit health reimbursement arrangements for 2026. All of the dollar limits currently in effect for 2025 will change for 2026, with the exception of one limit.

Read more here.

The Employee Retention Credit: IRS’s “Risking” Model Faces Legal Challenge

by Shawn O’Brien, Samuel Hamer and Michael Scarduzio | Apr 30, 2025 | Employee Benefits

In April 2025, the US District Court for the District of Arizona rejected a motion for a preliminary injunction filed by two tax preparation companies. These firms aimed to stop the Internal Revenue Service from using an automated “risk assessment model” to evaluate and reject Employee Retention Credit (ERC) claims, seeking to reinstate individualized reviews of ERC claims.

Read more here.

PBMs Score a Win in Federal Court Against State Regulation

by Alden Bianchi and Sarah Raaii | Apr 25, 2025 | Employee Benefits, Health and Welfare Plans

A recent federal court decision in McKee Foods Corp. v. BFP Inc. declared that Tennessee’s “any willing pharmacy” requirement was preempted by the federal Employee Retirement Income Security Act of 1974. This decision impacts self-funded group health plans, potentially allowing them to comply with a single set of rules nationwide rather than navigating conflicting state laws.

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Senate Committee Advances Bills to Tackle High Drug Prices, Enhance Market Competition

by Christopher M. Bruno | Apr 18, 2025 | Employee Benefits, Health and Welfare Plans

The US Senate Judiciary Committee has advanced six bills aimed at reducing pharmaceutical prices and improving market competitiveness. These bills address various issues, including limiting the number of patents a biologics license holder can assert in litigation, clarifying the boundaries of permissible settlements in “pay for delay” agreements, and preventing “product hopping” by branded drug manufacturers. Additionally, the bills seek to curb abuses of the US Food and Drug Administration’s citizen petition process, improve interagency coordination on patent information, and mandate the Federal Trade Commission publish a report analyzing pharmaceutical benefit manager pricing practices and the pharmaceutical supply chain.

Read more here.

The Employee Retention Credit: How to Litigate and Resolve Claims

by Shawn O’Brien, Samuel Hamer and Michael Scarduzio | Apr 10, 2025 | Employee Benefits, Employment

The Employee Retention Credit (ERC), introduced under the Coronavirus Aid, Relief, and Economic Security Act in March 2020, was designed to help employers retain employees during the COVID-19 pandemic by offering a refundable tax credit against certain employment taxes. However, the processing and payment of ERC claims have faced significant delays, with many claims remaining unprocessed or disallowed by the Internal Revenue Service (IRS).

In this Bloomberg Tax article, Shawn O’Brien, Samuel Hamer, and Michael Scarduzio summarize each ERC stage and outline a taxpayer’s path to payment by stage.

Access the article.

Navigating the Shifting Fiduciary Landscape

by Todd Solomon | Apr 8, 2025 | Employee Benefits, Retirement Plans

Todd Solomon recently appeared on the 401(k) Roundtable™ podcast. Hosted by Rick Unser of Creative Planning Retirement Services, the podcast is designed to help plan sponsors, fiduciaries, and members of retirement plan committees stay up to date on recent developments in the benefits industry.

During the episode, Todd explored the changing fiduciary landscape, trends in Employee Retirement Income Security Act litigation, the influence of the Trump administration on the US Department of Labor, and the evolving expectations surrounding fiduciary duties. He delved into the balance between the duty of loyalty and prudence, the significance of participant demographics in making plan decisions, and the difficulties plan sponsors face when weighing cost against value, particularly when choosing investments like target-date funds. Todd and Rick also stressed the importance of thorough documentation, active committee involvement, and creative approaches to improving participant outcomes in today’s intricate regulatory climate.

Listen on Apple Podcasts
Listen on Spotify

Reproductive Health Under Trump: What’s New and What’s Next

by Stacey Callaghan, Evie Atwater, Dexter Golinghorst and Caroline Reignley | Apr 1, 2025 | Digital Health, Employee Benefits, Health and Welfare Plans

Over the past two months, the second Trump administration has shifted federal policies and priorities regarding abortion, in vitro fertilization (IVF), contraception, and other reproductive-health-related matters – and it is expected to continue to do so.

Meanwhile, new regulatory developments in this area at the state level are also ongoing. Many states now require that insurance plans provide some combination of fertility benefits, fertility preservation, and coverage for a number of IVF cycles. After July 1, 2025, all large employers in California must provide insurance coverage for fertility treatments, including coverage for unlimited embryo transfers and up to three retrievals.

Read more here.

Breaking Down the New No Surprises Act FAQs Post-TMA III

by Drew Elizabeth McCormick, Jamie Gelfman, Kristen O'Brien, Jeffrey Davis and Abygail Hoey | Mar 25, 2025 | Employee Benefits, Health and Welfare Plans

On January 14, 2025, the US Departments of Labor, Health and Human Services, and the Treasury, along with the Office of Personnel Management, released Part 69 of a series of FAQs aimed at helping stakeholders understand and comply with the federal No Surprises Act.

This latest set of FAQs focuses on how health plans and issuers should determine the qualifying payment amount and includes updates to disclosure and patient cost-sharing requirements, reflecting the recent rulings by the US District Court for the Eastern District of Texas and the US Court of Appeals for the Fifth Circuit in the case of Texas Medical Association, et al. v. United States Department of Health and Human Services, et al.

Read more here.

Price Transparency: A Trump Administration Regulatory Priority

by Jeffrey Davis and Leigh Feldman | Mar 13, 2025 | Employee Benefits, Health and Welfare Plans

On February 25, 2025, the Trump administration highlighted one of its priorities in an executive order on price transparency. While the order primarily focuses on enforcing existing price transparency requirements, it also suggests potential changes or expansions, which would necessitate rulemaking. Potential impacts on health plans include the requirement to make detailed pricing information publicly available and to provide an online shopping tool. This tool will allow consumers to see the rates negotiated by their providers and plans, as well as an estimate of their out-of-pocket costs for 500 of the most shoppable items and services.

Read more here.

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