PBM Reform Under CAA 2026: What Employers Must Know
The newly enacted CAA 2026 introduces strict federal oversight for Pharmacy Benefit Managers (PBMs). ERISA group health plans must immediately secure compensation disclosures from PBMs before contracting. Starting in 2029, PBMs must pass through 100% of rebates to plans and provide detailed drug spending reports. Employers must diligently review their ERISA fiduciary duties today to avoid facing steep financial non-compliance penalties.
HHS Increases 2026 Penalties: HIPAA & Medicare Rules
HHS has released inflation-adjusted penalty increases for 2026, impacting HIPAA, Medicare Secondary Payer rules, and ACA violations. Effective January 28, 2026, fines are significantly higher. HIPAA Tier 4 violations now cap at over $2.19 million annually. Penalties for failing to provide SBCs or offering Medicare-eligible employees financial incentives to drop coverage also increased. Employers must audit compliance practices today.
Unlocking Health Plan Growth Via Capital Reinsurance
Health plan CFOs face mounting capital constraints as membership grows and medical costs rise. Capital motivated reinsurance (CMR) offers a flexible solution through quota share structures. By transferring reserve obligations to a reinsurer, plans unlock statutory capital without adding debt or diluting equity. Success requires strong financial performance, true risk transfer, and early regulator engagement to ensure compliance.
TrumpRx and Employer Plans: Not a Benefit Strategy
TrumpRx is a federal portal offering cash-pay discounts on a limited list of brand-name drugs, but it is not a replacement for employer-sponsored pharmacy benefits. Because purchases are made outside of insurance, they generally do not count toward employee deductibles or out-of-pocket maximums. Rather than relying on TrumpRx, employers should focus on managing PBM contracts, specialty drug trends, and employee communication.
Pet Insurance Is
Having a Moment —
Here’s Why Employers
Are
Paying Attention
Employee benefits continue to evolve alongside the modern workforce — and one offering gaining noticeable traction is pet insurance. What was once considered a niche perk is quickly becoming a meaningful voluntary benefit as employees look for ways to manage rising veterinary costs while protecting pets that many consider part of the family. For employers, the appeal is equally clear: pet insurance supports employee well-being without adding direct cost to the organization.
