Navigating State PBM Laws: Understanding ERISA Preemption and Compliance
READ TIME: 6 MINUTES Pharmacy benefit managers (PBMs) play a pivotal role in the U.S. healthcare system, managing prescription drug benefits on behalf of insurers and employer-sponsored health plans. However, rising concerns over PBM transparency, pricing practices, and reimbursement rates have led to an expanding patchwork of state-level legislation. For employers – especially those offering […]
Read moreFederal Agencies Announce Pause in Enforcement of 2024 Mental Health Parity Rule
READ TIME: 5 MINUTES On May 15, 2025, the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (IRS) (collectively, “the Departments”) issued an anticipated nonenforcement policy regarding the 2024 Final Rule implementing the Mental Health Parity and Addiction Equity Act (MHPAEA). This follows a legal challenge to the 2024 Final […]
Read moreJune 12, 2025
Compliance Alert
May 2025 Compliance Recap
In May, applicable large employers were focused on RxDC reporting, due in June, and the PCORI filing, due in July. The U.S. Departments of Labor, Health and Human Services, and the Treasury jointly announced a pause in enforcement of the 2024 Final Rule implementing the Mental Health Parity and Addiction Equity Act (MHPAEA), and a […]
Read moreFAQs about the Patient Centered Outcomes Research Institute (PCORI) Fee
The Patient-Centered Outcomes Research Institute (PCORI) fee initially applied from 2012 to 2019. However, in December 2019, the Further Consolidated Appropriations Act, 2020 extended the fee to 2029. The PCORI fee applies to all plans that provide medical coverage to employees. Medical coverage includes preferred provider (PPO) plans, health maintenance organization (HMO) plans, point-of-service (POS) […]
Read more
