The FDA has approved 83 biosimilars, but less than 10% of eligible biologic prescriptions are filled with one. PBM rebate structures keep branded biologics preferred. Here's what's driving the gap and what employers should demand at renewal.
DIR fees grew 107,400% in a decade and peaked at $9.5 billion. CMS reformed them out of Medicare. Your employer plan still has them. Here's where the money goes and what to do before the CAA catches up in 2029.
Your TPA handles administration, but ERISA fiduciary liability stays with you. With 155 ERISA lawsuits in 2025 and new CAA disclosure mandates, here's what to check in your ASA before renewal.
Healthcare costs are jumping 10% in 2026. A disengaged broker isn't neutral, they're a cost. Here's how to fire them, what to gather first, and how a Broker of Record change actually works.
The Transparency in Coverage rules require your health plan to post three machine-readable files every month. Most employers have no idea whether their vendor is actually doing it.
Your broker's carrier shortlist isn't built around your best premium. It's built around their easiest workflow. Here's what's actually driving those repeat recommendations.
Most PBM rebate guarantees protect the PBM, not your plan. Here's the specific contract language, audit rights, and reconciliation clauses that actually ensure rebates flow back to you.
Self-funded employers owe a PCORI fee by July 31 each year, filed on IRS Form 720. The 2026 rate is $3.84 per covered life for calendar-year plans, and first-timers rarely see it coming.
Illinois SB3114, the Transparency in Downcoding Act, passed 59-0 and 111-0 and awaits the Governor's signature. Self-funded ERISA plans are exempt, but the law exposes a claims practice every employer should be auditing.
The CAA requires brokers to disclose all compensation before your renewal is signed. Most employers never ask for it, and that creates real fiduciary exposure.
Form 5500 is due July 31 for December 31 plan years. Here's the 60-day checklist self-funded employers need to gather Schedule H, C, and A data and coordinate with their TPA before the deadline.
