In a significant ruling, the Tenth Circuit Court of Appeals has bolstered the position of ERISA (Employee Retirement Income Security Act of 1974) with a decision favoring pharmacy benefit managers (PBMs). The case, Pharmaceutical Care Management Association v. Mulready, highlighted the ongoing tension between state laws and the powers granted by the aforementioned federal statute….
Last month, numerous pivotal judgments unfolded in the sphere of the Employee Retirement Income Security Act (ERISA), shedding light on issues surrounding lawsuit timing, the substantiation needed for an LTD termination resolution, court’s discretion to credit and discredit expert opinions, the pretext an insured might need to demonstrate they were prejudiced by the conduct of…
In an unexpected development, the Ninth Circuit has once again revised its opinion in the Wit v. United Behavioral Health case. Affirming its prior ruling that denied motion to vacate and superseding its prior Wit Opinion, the federal appellate court has been persistent in its adaptations. This index case involves patients struggling with mental health…
In a notable legal conclusion, fiduciaries of a retirement plan, sponsored by DST Systems Inc., inclusive of the investment management firm Ruane, Cunniff & Goldfarb Inc., have agreed to settle for an amount exceeding $124.6 million over alleged violations of the Employee Retirement Income Security Act (ERISA). This settlement was reached in response to a…
In a significant legal development, the U.S. Court of Appeals for the Tenth Circuit recently made a ruling that could reshape the future state regulation of pharmacy benefit managers (PBMs). The case in question, Pharmaceutical Care Management Association (PCMA) v. Mulready, was decided on August 15, 2023, and tackled the complex relationship between state authority…
On August 15, 2023, the U.S. Court of Appeals for the Tenth Circuit spoke on a significant development concerning Patient’s Right to Pharmacy Choice Act Title 36 § 6958 et seq of 2019 from Oklahoma. The verdict was laid out in Pharmaceutical Care Management Association v. Glen Mulready, where the official capacity of Glen Mulready…
In a recent decision, the Tenth Circuit ruled that the Employee Retirement Income Security Act of 1974 (ERISA) preempts provisions of an Oklahoma law regulating pharmacy benefit managers (PBMs) and pharmacy networks. This judgment offers a significant victory for self-funded health plans subject to ERISA. The Tenth Circuit serves a jurisdiction that includes Oklahoma and…
The past week has seen some noteworthy activity within the Ninth Circuit Court. Two key subjects of interest include ERISA claims and the statute of limitations for an action by the Federal Energy Regulatory Commission (FERC). In connection with ERISA (Employee Retirement Income Security Act), the Court is considering allegations that a plan administrator overstepped…
Given their unpredictable nature and often significant implications, Department of Labor (DOL) retirement plan audits have a justifiable reputation for inducing anxiety. These investigations, infamous for their meticulous scrutiny and potentially severe financial consequences, can undoubtedly be daunting. As such, it seems entirely rational to experience a certain degree of apprehension or even fear when…
In a recent, much-anticipated judgement given on August 15, 2023, the Tenth Circuit Court decided the PCMA v. Mulready case, rejecting Oklahoma’s argument that its pharmacy network requirements were not preempted by ERISA (The Employee Retirement Income Security Act). A detailed report on this judgment can be found in an article in JD Supra. The…
In a strong legal stance, the U.S. Court of Appeals for the 10th Circuit issued a decision that reinforces long-standing federal protections. This decision primarily impacts employer and union-sponsored health plans, emphasizing their rights to design their own health benefit plans, including provider networks. Further pivotal to this judgement is the assertion that it is…
Profound changes to the world of energy finance are coming down the pipeline, courtesy of the US Treasury. The Inflation Reduction Act of 2022 (IRA) presented generous tax credits for certain clean energy investments, a benefit for many firms focused on wind and solar farm projects. These incentives, essentially offering up to 50% of the…
The Pension Benefit Guaranty Corporation (“PBGC”) has recently released Technical Update Number 23-1, providing an initial alleviation in the form of limited waiver from the reporting requirements under the Employee Retirement Income Security Act (ERISA) section 4010 for some underfunded pension plans. This comes as a result of the 2022/2023 market conditions, as per this…
The regulation and licensing of professionals across various industries has long been a mitigating factor in preventing malpractice and ensuring quality service. Peculiar, however, is the case when it comes to third party administrators (TPAs). It appears just about anyone with a sign can label themselves a TPA. This unexpected revelation questions the need for…
In a recent development, the US District Court for the Southern District of New York has come to a landmark decision that supports the issuers of residential mortgage-backed securities (RMBS) in a prolonged dispute pertaining to the Employee Retirement Income Security Act of 1974, as reported by Morgan Lewis. The ruling weighs heavily on the…
In a critical update to the case of D.K. et al. v. United Behavioral Health et al., the Tenth Circuit Court has chosen not to revisit its decision requiring significant changes to health plan denial letters. As a focal point in the health benefits field, the implications of this lawsuit and the ensuing rulings carry…
The US Department of Labor (DOL) has undertaken an investigatory initiative centered around the serious issue of “insurability” under life insurance benefits, as highlighted in a recent news release. The problem herein lies in the failure to complete the process of confirming the evidence of insurability. The evidence of insurability can be described as the…
Heightened attention is currently being paid to ERISA excessive fee cases as many continue to withstand dismissal motions. Cases falling under the Employee Retirement Income Security Act of 1974 (ERISA) revolving around excessive fees have been able to push past these procedural hurdles at a remarkably high rate, drawing the focused consideration of legal professionals…