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Articles by Kara Maddalena
What ERISA Plan Sponsors Should Know About the FTC-Caremark PBM Settlement
The FTC's second major PBM settlement with Caremark continues to reshape how ERISA plan sponsors must evaluate PBM contracts and fiduciary oversight of pharmacy benefit arrangements. On July 14, 2026, the FTC announced a settlement with Caremark Rx LLC and Zinc Health Services LLC (collectively, "Caremark") resolving the FTC's administrative antitrust case alleging that Caremark used rebate-driven formulary practices that inflated insulin list prices and increased patient costs.
Sweeping Reform Raises the Stakes for PBMs and ERISA Fiduciaries | JD Supra
Early 2026 marks a coordinated turning point in the federal regulation and oversight of pharmacy benefit managers (PBMs), and these new PBM rules have significant fiduciary implications for ERISA group health plan sponsors. This alert summarizes these changes and how plan sponsors should prepare.
EXPERT INSIGHTS-CALIFORNIA SB 41: PHARMACY BENEFIT MANAGERS NOW HELD TO FIDUCIARY AND TRANSPARENCY STANDARDS
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California SB 41: Pharmacy Benefit Managers Now Held To Fiduciary And Transparency Standards
Davis Wright Tremaine are most popular: within Immigration topic(s) with readers working within the Business & Consumer Services, Consumer Industries and Healthcare industries California establishes fiduciary duties and transparency mandates for PBMs, reshaping the PBM contracting landscape with health plans beginning in 2026 California recently enacted California Senate Bill 41 ("SB 41"), a landmark law that fundamentally overhauls the regulation of pharmacy benefit managers ("PBMs") in the...
New Guidance Issued on Mandatory and Optional Catch-Up Provisions Under SECURE 2.0 | JD Supra
Three top takeaways for employee benefits professionals New guidance facilitates the implementation and operation of two important SECURE 2.0 features: mandatory Roth catch-up contribution rules for high-income participants, and the optional "super" catch-up contributions permitted for participants aged 60-63.
New Guidance Issued on Mandatory and Optional Catch-Up Provisions Under SECURE 2.0
Three top takeaways for employee benefits professionals New guidance facilitates the implementation and operation of two important SECURE 2.0 features: mandatory Roth catch-up contribution rules for high-income participants, and the optional "super" catch-up contributions permitted for participants aged 60-63.
San Francisco's Health Care Security Ordinance - Five Traps For The Unwary
San Francisco's Health Care Security Ordinance – Five Traps For The Unwary Do you have any San Francisco-based employees? If so, you may be subject to the San Francisco Health Care Security Ordinance ("SFHCSO"), a complex set of rules requiring certain minimum employer... United States Food, Drugs, Healthcare, Life Sciences Do you have any San Francisco-based employees?
San Francisco’s Health Care Security Ordinance – Five Traps for the Unwary | JD Supra
What employers should know about health coverage contribution requirements for San Francisco-based employees Do you have any San Francisco-based employees? If so, you may be subject to the San Francisco Health Care Security Ordinance ("SFHCSO"), a complex set of rules requiring certain minimum employer contributions toward San Francisco employee health coverage. Read on for a summary of the SFHCSO requirements, as well as five compliance traps to avoid.
San Francisco Health Care Security Ordinance – New Expenditure Rates for 2024 | JD Supra
The San Francisco Health Care Security Ordinance ("SFHCSO") requires Covered Employers to make certain minimum Health Care Expenditures on a quarterly basis for their Covered Employees. Those employers should take note of the new Health Care Expenditure Rates, as well as the increased salary amount for exempt managers, supervisors, or confidential employees who do not qualify as Covered Employees, both effective January 1, 2024.
San Francisco Health Care Security Ordinance - New Expenditure Rates for 2024
The San Francisco Health Care Security Ordinance ("SFHCSO") requires Covered Employers to make certain minimum Health Care Expenditures on a quarterly basis for their Covered Employees. Those employers should take note of the new Health Care Expenditure Rates, as well as the increased salary amount for exempt managers, supervisors, or confidential employees who do not qualify as Covered Employees, both effective January 1, 2024.
Prudent Plan Governance Essential in Defense Against Fiduciary Breach | JD Supra
Roadmap for successful plan governance Although retirement plan excessive fee cases remain an ongoing concern for plan sponsors, the recent jury trial victory for Yale in Vellali, et. al. v. Yale University, et. al. provides hope for plans with strong, prudent plan governance. Given the pace of new excessive fee lawsuits and the verdict in Yale, plan sponsors should review their plan governance procedures as soon as possible for compliance with the roadmap below.
Prudent Plan Governance Essential in Defense Against Fiduciary Breach
Although retirement plan excessive fee cases remain an ongoing concern for plan sponsors, the recent jury trial victory for Yale in Vellali, et. al. v. Yale University, et. al. provides hope for plans with strong, prudent plan governance. Given the pace of new excessive fee lawsuits and the verdict in Yale, plan sponsors should review their plan governance procedures as soon as possible for compliance with the roadmap below.
Excessive Fee Litigation Spreads to Health Plans | JD Supra
Self-funded plan sponsors should review health claims data to ensure participants are not being overcharged by third party administrators Excessive fee litigation is no longer confined to defined contribution plans. In recent months, plan sponsors of self-funded health plans have filed three cases against Aetna, Elevance, Inc. (formerly known as Anthem, Inc.), and Blue Cross Blue Shield of Massachusetts in their capacities as third-party administrators ("TPAs") under similar theories of liability.
New FAQs Address No Surprises Act Impact on ACA Maximum Out-of-Pocket Limits and Facility Fee Transparency | JD Supra
Employers should ensure their service providers and insurers are correctly processing claims to mitigate litigation risks Employers should be aware that the No Surprises Act has an impact on the maximum-out-of-pocket ("MOOP") limit for annual cost-sharing under the Affordable Care Act ("ACA") and facility fee transparency.
Agencies Release FAQs Confirming Impact of End of the COVID-19 Emergency Declarations on Employee Benefit Plans | JD Supra
Employers should prepare now for impacts to their employee benefit plans when the COVID-19 Outbreak Period expires. On March 29, 2023, in anticipation of the ends of both the National Emergency and Public Health Emergency, the Department of Labor, Health and Human Services, and the Treasury (the "Agencies") released new Frequently Asked Questions ("FAQs") to address how certain deadlines and coverage changes will function going forward.
San Francisco Health Care Security Ordinance: Form Due May 1 | JD Supra
Employers covered by the San Francisco Health Care Security Ordinance ("SFHCSO") must submit their Annual Reporting Form to the San Francisco Office of Labor Standards Enforcement ("OLSE") on or before May 1, 2023. Covered Employers should also be aware that effective January 1, 2023, OLSE released a new poster to be posted in all workplaces with Covered Employees (and to be distributed to remote Covered Employees), as well as issued new 2023 required Health Care Expenditure rates.
San Francisco Health Care Security Ordinance: Form Due May 1
Employers covered by the San Francisco Health Care Security Ordinance ("SFHCSO") must submit their Annual Reporting Form to the San Francisco Office of Labor Standards Enforcement ("OLSE") on or before May 1, 2023. Covered Employers should also be aware that effective January 1, 2023, OLSE released a new poster to be posted in all workplaces with Covered Employees (and to be distributed to remote Covered Employees), as well as issued new 2023 required Health Care Expenditure rates.
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