BENEFITS DIGEST

Marsh's national survey of more than 1,800 employers projects health benefit costs rising 8.2% in 2027, the sharpest annual jump since 2003, and 11% for employers who take no action. Some 59% plan cost-reduction moves such as raising deductibles, and GLP-1 coverage alone accounts for about a percentage point of the increase.

This week's roundup, a short-handed edition with no case of the week, flags two decisions as most notable. In Central States v. McClain the Seventh Circuit held that Arkansas's latest pharmacy benefit manager regulation survives ERISA preemption, and in Liu v. Kaiser the Ninth Circuit extended the substantial compliance doctrine to benefit elections. The edition also collects the week's decisions on arbitration, attorneys' fees, fiduciary breach, disability claims, preemption, exhaustion, and pleading.

New Lockton data shows Texas employer health spending rising on medical prices, hospital market consolidation, and prescription drug costs even as utilization levels off.

Attorneys from McDermott Will & Schulte review the costs, benefits and risks for employers to evaluate when deciding how their benefits address these popular medications.

A deal between rival drug middlemen Prime Therapeutics and Express Scripts depressed reimbursement rates for pharmacies, according to the new complaint. It is the latest legal challenge against the partnership.

Employers face another steep rise in healthcare expenses in 2027, prompting a closer look at GLP-1 coverage, pharmacy spending and high-cost conditions.

In Larkin v. Caremark Rx, No. 1:25-cv-07307 (S.D.N.Y.), participants allege the PBM wrongfully denied coverage for the GLP-1 drug Zepbound on medical-necessity grounds while steering them to Wegovy. According to early reports, the court has now declined to compel arbitration based on an arbitration provision in CVS's website terms of use, letting the ERISA coverage claims proceed. The order itself is not yet publicly posted, and the decision date is unconfirmed.

From unexpected babies to "Ozempic teeth," the ultra-popular class of GLP-1 medications are turning out to have a few unanticipated side effects. Emerging research shows the drugs, which have proven effective in treating obesity and diabetes, may also be useful in treating addiction.

After years of arguing over what GLP-1 coverage should cost, employers are starting to ask the harder question: whether it is paying off. EBN on the early return-on-investment evidence and how benefit teams are measuring it.

We describe how employer-sponsored health plans can use audits of their pharmacy benefit managers to identify operational and performance issues and help control drug cost expenditures.

Under pressure to stay competitive while controlling costs, employers are turning new scrutiny on PBM contracts, hospital prices, and GLP-1 coverage heading into 2027 planning.

Mercer's quarterly state survey: Virginia enacted both paid family and medical leave and paid sick and safe leave, several states passed major PBM laws including a Tennessee statute challenged in court the day it took effect, and Alabama, Georgia, and Texas legislated on AI use in benefits.

A practical roundup of the coverage decision every health plan is facing: GLP-1 demand keeps climbing, the costs are reshaping budgets, and experts weigh the alternatives benefit leaders are actually considering.

Employers name high drug prices, high-cost claims, and hospital prices as their biggest affordability threats, and most say healthcare inflation is now eating directly into salary budgets. The compensation-side echo of the 10 percent trend number IFEBP put up last week.

The FTC's July settlement with Caremark resolved allegations that rebate-driven formulary practices inflated insulin list prices and patient costs. DWT draws out the plan-sponsor implications, a companion to yesterday's IFEBP settlement-terms analysis.

Recent FTC orders require Caremark Rx and Express Scripts to stop favoring high-list-price drug versions over their standard formularies. IFEBP looks at the settlement terms most relevant to plan sponsors and members.

CMS staffers intend to use the data they collect to implement new federal rules for pharmacy benefit managers serving self-insured employer health plans, an early signal for plan sponsors watching the PBM regulatory front.

Rising use of the weight-loss drugs is fueling the fastest health plan cost growth in a decade and a half, forcing employers to rethink coverage strategies and cost management.

A Milliman white paper on the GLP-1 market's dramatic growth, with U.S. spending rising from $13.7 billion in 2018 to $71.7 billion in 2023, now the largest and fastest-growing drug category. The authors examine payer coverage policies, utilization management, and cost containment, and urge payers to evaluate total cost of care, adherence durability, and long-term clinical return on investment rather than drug unit costs alone.

While multiple states have passed laws that regulate and reform policies of pharmacy benefit managers (PBMs), these laws have faced a recent deluge of legal challenges in federal court by industry groups and some plan sponsors.

ARA analysis of the JPMorgan prescription-drug fiduciary litigation, where a health plan excessive-cost suit survived dismissal in part on arguments drawn from a recent Supreme Court decision. The piece examines why a documented process may not end the inquiry when plaintiffs plead prohibited-transaction claims.

Physician and outpatient services and prescription coverage pose a significant threat to US fiscal resources, according to Boston College’s Center for Retirement Research.

As the popularity of GLP-1 medications continues to rise and the list of conditions being treated with these medications grows, plan sponsors are taking a closer look at the costs and benefits of GLP-1 coverage.

Newly released International Foundation survey data revealed key trends for glucagon-like peptide-1 (GLP-1) drug coverage for U.S. corporate employers.

“If at first you don’t succeed, try, try again” is a famous quote with unclear origins dating back over 200 years. It is a saying that plaintiff firms appear to have used as inspiration for their

Proposed rule requiring PBMs servicing group health plans to disclose direct and indirect compensation to plan fiduciaries, extending the ERISA §408(b)(2) service-provider fee-disclosure framework