The Daily Brief for Benefits Professionals
BenefitsWire
Health & Welfare Plans
August 21, 2026
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11 items · ~4 min read
Top of the Brief
Why PBM audits matter: 3 ways that auditing a pharmacy benefit manager can help employer-sponsored health plans manage prescription drug costs“For employer-sponsored health plans, prescription drugs may represent one of the most expensive, fastest-growing, and least transparent areas of benefit costs. Pharmacy benefit managers (PBMs) play a central role in administering pharmacy benefits; establishing retail, mail order, and specialty pharmacy networks; negotiating pharmacy reimbursement terms; remitting rebates from drug manufacturers; managing formularies; and processing claims. Given the complexity of managing these benefits, even well-run plans can face issues such as pricing discrepancies, operational errors, or contract terms that no longer reflect current market standards. PBM audits play an important part in minimizing thes”
In this issue
Regulatory Action and Guidance (2) · Health & Welfare Plans (2) · Litigation (3) · General Benefits (2) · Press Releases (1) · Webinars (1)
Regulatory Action and Guidance
2 items“Contributions of up to $5,000 per year (indexed for inflation after 2027) can be made to the Accounts. Employers can contribute up to $2,500 (indexed for inflation after 2027) per employee to the Accounts of employees or their dependents. The federal government will provide a $1,000 seed contribution for eligible children born in 2025, 2026, 2027, and 2028. Many large companies and private donors have pledged to match the federal government’s seed contribution made to employees’ dependents’ Accounts or to make separate contributions to the Accounts.” MORE >>
Source: Boutwell Fay
“The U.S. Department of Labor (DOL) recently proposed a new rule (the “Proposed Rule”) that would offer group health plan administrators an additional safe harbor for electronically furnishing required group health plan disclosures to participants and beneficiaries. If finalized, the Proposed Rule would give group health plan administrators a modernized alternative to the current, more limited, electronic delivery framework. The Proposed Rule is modeled closely on a more permissive notice-and-access safe harbor the DOL previously adopted for retirement plans in 2020 (the “2020 Retirement Plan Safe Harbor”), which makes electronic delivery of retirement plan documents the default, subject to a” MORE >>
Source: National Law Review
Health & Welfare Plans
2 items“For employer-sponsored health plans, prescription drugs may represent one of the most expensive, fastest-growing, and least transparent areas of benefit costs. Pharmacy benefit managers (PBMs) play a central role in administering pharmacy benefits; establishing retail, mail order, and specialty pharmacy networks; negotiating pharmacy reimbursement terms; remitting rebates from drug manufacturers; managing formularies; and processing claims. Given the complexity of managing these benefits, even well-run plans can face issues such as pricing discrepancies, operational errors, or contract terms that no longer reflect current market standards. PBM audits play an important part in minimizing thes” MORE >>
Source: Milliman
“According to a recent survey by the nonprofit Sentio Marriage and Family Therapy program, 49% of people who use large language models like ChatGPT and report having an ongoing mental health condition said they use AI for mental health support. Among them, 73% said they use it to manage anxiety, 60% for depression support, 58% for emotional insight, 56% to improve their mood, and 35% to feel less lonely. As leaders look for new ways to leverage technology to support their workforces, they'll need to carefully vet and implement AI tools to ensure they deliver positive outcomes. "The reason AI has become very popular in mental health is because it's significantly more convenient for people," sa” MORE >>
Source: Employee Benefit News
Litigation
3 items“In Laurel Hill Mgmt. Servs., Inc. v. La-Z-Boy Inc., No. 25-1727, — F.4th —-, 2026 WL 2427143 (6th Cir. Aug. 19, 2026), several out-of-network medical providers treated a patient covered under La-Z-Boy’s ERISA-governed health benefit plan after Blue Cross Blue Shield of Michigan, the plan administrator, orally represented that it would reimburse them at the usual, customary, and reasonable (UCR) rate. Blue Cross instead paid the providers $1,598.40 on claims of $342,296, an amount based on Medicare rather than the represented UCR rate. The providers sued La-Z-Boy and Blue Cross in California state court, asserting state-law claims for negligent misrepresentation and promissory estoppel and se” MORE >>
Source: Roberts Disability Law
“66 Franklin Street, Suite 300 Oakland, CA 94607 In Aloff v. The Prudential Insurance Company of America, No. 3:25-cv-05834-DGE, 2026 WL 2389181 (W.D. Wash. Aug. 17, 2026), United States District Judge David G.” MORE >>
Source: Roberts Disability Law
[Regulatory Action and Guidance]
Federal judge vacates Trump admin restrictions on ACA gender-affirming care“The ruling keeps financial protections for gender-affirming care in place, but doesn’t address whether federal or state regulators will direct insurers to revise benefit documents, recalculate cost sharing or revisit claims processed under the now-vacated policy. Plans will need guidance from CMS and states on how to proceed with coverage changes or adjustments, according to AHIP, the insurance industry’s largest trade group. The HHS did not respond to questions about whether the administration plans to appeal or seek a stay, or how issuers and states should administer existing plans while the ruling remains in effect.” MORE >>
Source: Healthcare Dive
General Benefits
2 items“Find Your Next Job ! The NEP identifies employment practices involving diversity, equity, inclusion, and belonging (DEIB) initiatives as a potential area of enforcement focus, particularly where such programs may influence hiring, promotion, or other employment opportunities based on protected characteristics.” MORE >>
Source: National Law Review
Senators Wyden and Warren urged FINRA to strengthen cybersecurity and consumer protections for ACATS transfers to prevent brokerage fraud, impacting account transfer security. MORE >>
Source: Senate Finance Committee
Press Releases
1 item[Litigation]
PGIM Taps Industry Veteran Yaqub Ahmed to Lead DC Solutions“PGIM announced today that Yaqub (“Qub”) Ahmed has joined the firm as head of Defined Contribution (DC) Solutions, where he will lead PGIM’s holistic DC strategy across institutional and wealth channels, bringing the full breadth of its investment and advice capabilities to plan sponsors, consultants, advisors, and the participants they serve. “I’m energized by the opportunity to build on PGIM’s long-standing success in the retirement market and develop innovative solutions that deliver better outcomes for clients.” PGIM, the $1.5 trillion global asset management business of Prudential Financial, Inc., noted in a press release today that the appointment comes as the DC market enters a signifi” MORE >>
Source: 401(k) Specialist
Webinars
1 item“Trump Accounts (“Accounts”) launched on July 4, 2026. The Accounts are intended to be a treasure chest where wealth can be stashed away for children until they turn 18. While the Accounts’ statutory framework has been established, the government is still hammering out the regulatory details to keep them shipshape.” MORE >>
Source: Boutwell Fay