Pharmacy Benefit Managers (PBMs) — the powerful intermediaries managing prescription drug benefits for insurers, employers, and government programs — are facing new levels of scrutiny from regulators, lawmakers, and industry stakeholders.

This proposal reflects a broader shift toward more restrictive oversight of inpatient utilization. As CMS finalizes this policy, providers should be aware of the immediate compliance and reimbursement risks associated with the phase-out.

Major Medicare Advantage (MA) insurers are facing increased scrutiny—not just from the federal government, but also in their relationships with hospitals and enrollees.

As a follow-up to our earlier post on the rise of ICHRAs, employers should be aware of significant changes incorporated in recently passed “One Big Beautiful Bill.”

A district court out of Connecticut recently held that the No Surprise Act (“NSA”) creates a private cause of action that allows a prevailing party to enforce an Independent Dispute Resolution (“IDR”) award.

On April 3, 2025, Florida Senate passed bill SB480. The bill, if enacted into law, will authorize nonprofit agricultural organizations to provide “medical benefit plans” to their members.

Individual Coverage Health Reimbursement Arrangements (ICHRAs) are a relatively new approach to employer-sponsored health coverage.

The Federal Independent Dispute Resolution (IDR) process, established under the No Surprises Act (NSA), was designed to resolve out-of-network payment disputes between providers and insurers.

The Supreme Court of the United States will hear arguments this spring from a case that threatens to rollback insurance coverage on preventative care.

Calculators, or “adding machines” as they were once called, once represented revolutionary technology.