The topic of “food as medicine” has gained increased attention recently, driven by a growing recognition of the role nutrition plays in preventing and managing chronic diseases. However, marketplace participants continue to face various hurdles, such as funding and reimbursement, in launching initiatives and demonstrating their value and beneficial impact on global health and well-being.
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.
With a new presidential administration, the changing regulatory landscape regarding health benefits – often, the second-largest expense for a business after salaries – has been top of mind for HR executives. Much of the early commentary focused on contested “red state/blue state” issues, such as gender-affirming care. The president’s ever-growing list of executive orders now gives us additional hints about the health benefits items that have attracted the administration’s interest and driven changes in health plan regulation trends.
In this HR Executive article, Sarah Raaii and Alden Bianchi discuss five key health plan regulation trends that HR executives should watch under the new administration.
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.
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.
In recent telehealth news, the governor of Mississippi has signed SB 2415 into law, which mandates that health insurance plans cover telemedicine services to the same extent as in-person consultations. The bill also requires that all health insurance and employee benefit plans in Mississippi reimburse out-of-network providers for telemedicine services under the same reimbursement policies applicable to other out-of-network providers.
Read more about other telemedicine-related legislative and regulatory developments in our monthly Trending in Telehealth report.
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.
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.
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.
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.
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