Medication

March 13, 2026

RxDC surveys are here, respond promptly

Employers sponsoring group medical and Rx plans should watch for their carrier or TPA's annual questionnaire requesting employer vs. employee premium contribution data, needed to complete RxDC reporting by the June 1 deadline. Self-funded plans have additional calculation considerations, and any gaps in submissions must be resolved through HIOS or a third-party vendor.

March 2, 2026

Federal pharmacy benefits manager (PBM) reforms are here

New federal rules are reshaping how employers oversee PBM contracts and compensation. A proposed DOL rule (effective as early as July 2026 for some plans) and a new law signed in February 2026 (effective 2028-2029) will require greater PBM transparency, new participant notices, and full pass-through of rebates and fees for ERISA plans. Employers should begin reviewing PBM contracts and fiduciary processes now, as non-compliance carries penalties up to $10,000 per day.

October 1, 2025

Price transparency rule

On September 2, 2025, the Department of Health and Human Services (HHS) published a final rule to enable better real-time cost-sharing of prescription drug benefits and speed up the process of securing prior authorizations for medications. The rules will modernize electronic prescribing, allow real-time prescription benefit checks (which show the drug cost for the insured patient at various pharmacies and what they could pay for alternative medications), and streamline prior authorization with modern API technology.