March 5, 2025. By Anne Tyler Hall and Tim Kennedy*-Hall Benefits Law A plan sponsor’s fiduciary duty to be transparent in Pharmacy Benefit Manager contracts safeguards plan participants’ interests and mitigates the risk of litigation, regulatory penalties, and reputational harm, say Hall Benefits Law practitioners. Pharmacy Benefit Managers (PBMs), particularly the Big 3 PBMs (CVS Caremark, Express Scripts, and Read More

Law360 (February 28, 2025, 8:32 PM EST) -- The Ninth Circuit will mull Express Scripts and OptumRx's bid to force a public nuisance suit brought by the state of California into federal court, and the Second Circuit will hear from pensioners who say that IBM's use of outdated mortality tables shrank their benefits payouts. Here are five appellate arguments happening in March that should be on benefits lawyers' Read More

Law360 (February 14, 2025, 7:11 PM EST) -- Skyrocketing prescription drug costs and a proliferation of state laws are driving renewed calls from employers and benefit plan administrators for Congress to enact federal legislation changing how pharmacy benefit managers do business, experts say.Employee benefits and healthcare industry groups are redoubling efforts to have Congress pass a set of new reporting and rebate Read More

Law360 (June 10, 2024, 5:46 PM EDT) -- The Ninth Circuit's recent decision finding Cigna is off the hook for $8.6million in out-of-network mental health and substance use disorder treatment claims against employee benefit plans administered by the insurer could discourage similar litigation, benefits attorneys say. The Ninth Circuit on May 31 upheld a California court's grant of summary judgment to Cigna on claims Read More

By Bonita Hatchett-Bodle (April, 2024) The Department of Labor (DOL) Wage and Hour Division issued final regulations, effective March 11, 2024, which are intended to serve as a practical guide to employers on how the DOL determines whether a worker is an employee or independent contractor under the Fair Labor Standards Act (FLSA) [29 CFR part 795]. This new guidance may impact employee classification under the Read More

January 17, 2024 | Leah Shepherd Employers that sponsor group health plans need to ensure they are in line with a new annual requirement to vouch that they are complying with a federal price transparency rule. The reporting requirement was part of the No Surprises Act, which passed in 2021 as part of the Consolidated Appropriations Act. It prohibits group health plans from entering into any agreement that prevents Read More

By Kellie Mejdrich Law360 (January 12, 2024, 6:02 PM EST) -- The U.S. Department of Labor's recently finalized rule toughening the test for determining whether someone qualifies as an independent contractor or an employee under federal wage and hour law may make businesses rethink deeming workers contractors. The DOL's final rule, published in the Federal Register on Wednesday, sets out a six-factor, nonexhaustive Read More

By Tim Kennedy and Anne Tyler Hall (October 31, 2023) In recent years, the U.S. has seen an increase in the number of individuals identifying as transgender.[1] With this development, there also has been increased attention on transgender rights and protections, as well as an increase in the demand for employer-sponsored group health plans, or GHPs, to cover gender-affirmation benefits. Whether or how a GHP Read More

By Grant Shuman and Anne Tyler Hall, Hall Benefits Law SECURE 2.0 provides retirement plan sponsors an avenue to control the narrative in resolving any compliance issues under EPCRS, say Grant Shuman and Anne Tyler Hall of Hall Benefits Law. Retirement plan sponsors can take advantage of new and expanded self-correction remedies under the Employee Plans Compliance Resolution System even before the IRS releases Read More