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Seyfarth Synopsis: The DOL’s latest MHPAEA guidance gives plan sponsors a practical roadmap for where parity compliance reviews should focus next. Although the DOL has announced limited nonenforcement relief for certain portions of the 2024 Final Rule, the agency made clear that it continues to enforce MHPAEA’s core statutory requirements, including the obligation to prepare and maintain written NQTL comparative analyses. The key takeaway is to review written plan terms and operational practices for warning signs involving treatment exclusions, medical necessity, utilization management, and network adequacy, and to make sure service providers will provide support.

Consistent with the DOL’s enforcement priorities for 2026, earlier this week the Department of Labor (“DOL”) released Field Assistance Bulletin No. 2026-03 and an accompanying web page (“Identifying Potential Problems: If You See the Following in Written Plan Provisions or Plan Operations, Think Twice about Possible MHPAEA Compliance Problems”), which spotlight three key focus areas for enforcement and provide a checklist for identifying warning signs that might indicate potential compliance problems under the Mental Health Parity and Addiction Equity Act (MHPAEA).

Three Key Focus Areas

The Field Assistance Bulletin explains that the DOL intends to focus its MHPAEA NQTL enforcement on three areas where it sees significant risk of participant harm:

  1. Treatment exclusions for mental health and substance use disorder benefits;
  2. Medical necessity and utilization management processes, including prior authorization, concurrent review, and related claims review standards; and
  3. Network adequacy and provider reimbursement, including standards for admitting MH/SUD providers to networks and methodologies that may contribute to inadequate access.

Employer Takeaway: According to the guidance, these are the places the DOL is most likely to look first. Treat the DOL’s three focus areas as the starting point for your next MHPAEA review.

Continue Reading DOL Hands Employers a Mental Health Parity Roadmap
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Seyfarth Synopsis: The Department of Health and Human Services has delegated enforcement authority to the Office of Civil Rights for 42 CFR Part 2, which protects the confidentiality of substance use disorder records. Covered entities must update their HIPAA documents to reflect these changes by February 16, 2026.

On August 25, 2025, the U.S. Department of Health and Human Services (HHS) Office of the Secretary authorized the Director of the Office for Civil Rights (OCR) to enforce the “Confidentiality of Substance Use Disorder (SUD) Patient Records” regulations found at 42 CFR Part 2, including the right to impose civil penalties, issue subpoenas and take corrective actions for noncompliance. These rules, finalized in February 2024, aim to protect the privacy of patients’ SUD treatment records, and require updates to HIPAA Privacy Policies and Notices of Privacy Practices.

Continue Reading Enforcement of Substance Use Disorder Records
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Seyfarth Synopsis: Recently the IRS issued Rev. Proc. 2025-32 and 2025-61, announcing the cost-of-living adjustments to certain welfare and fringe benefit plan limits for 2026 and applicable dollar amounts for the remainder of 2025.

2026 Limits for Certain Health and Fringe Benefits

The Affordable Care Act (ACA) established the Patient-Centered Outcomes Research Institute (“PCORI”), to…

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Seyfarth Synopsis: On July 4, 2025, Donald Trump signed the One Big Beautiful Bill (OBBB) into law. Although most have focused on the sweeping tax reform included in the OBBB, a number of key employee benefits provisions are included in the OBBB as well. Most significantly, the OBBB expands access to and eligible expenses payable…

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Seyfarth Synopsis: In a closely watched decision, the Supreme Court has upheld the authority of the U.S. Preventive Services Task Force (Task Force), preserving the Affordable Care Act’s (ACA) requirement that health plans cover preventive services–such as HIV prevention medication–without cost sharing. The ruling ensures continued access to a wide range of preventive care for…

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Seyfarth Synopsis: As expected, the lawsuits have commenced following the enactment of the Arkansas legislation prohibiting pharmacy benefit managers (PBM’s) from owning or operating actual pharmacies within the state. Michigan has filed its own lawsuit against PBMs. Further, a similar bill targeting PBMs is winding its way through the Illinois legislature.

Arkansas Law

As we discussed in our blog post here, Arkansas recently became the first state in the nation to prohibit licenses for retail, mail order or specialty pharmacies that are owned (directly or indirectly) by a PBM. The law does contain a limited exception that allows the issuance of licenses to PBM-affiliated pharmacies for certain rare, orphan, or limited distribution drugs, but this window for exceptions closes in September 2027 (presumably intended to provide a transition period to source these drugs through pharmacies not affiliated with PBMs). 

PBM Reaction

Two lawsuits have now been filed by PBMs challenging Arkansas’ authority to pass this legislation. The lawsuits allege harm to residents of Arkansas by causing the closure of many brick and mortar pharmacies across the state and the inability to access mail-order pharmacies. Express Scripts, in its suit, argues that the Arkansas state law violates several provisions of the United States Constitution, claiming that:

  • the intended purpose of the state statute — to protect local pharmacies — violates the Commerce Clause.
  • the protectionist purpose of burdening out-of-state citizens violates the Privileges and Immunities Clause
  • the singling out of PBMs and their affiliated pharmacies for punishment violates the Attainder Clause, which bars legislative punishment (including banishment) of specific groups.

Because Express Scripts and its affiliates provide services to the US Defense Department’s TRICARE program, the suit also claims that the state statute is preempted by the federal law and regulations surrounding that program.

Arkansas has not yet filed its response to the suits.

Continue Reading States Seeking Remedies for the Rising Costs of Prescription Drugs
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Seyfarth Synopsis: On May 15, 2025 the Departments of Labor, Health and Human Services, and Treasury (the “Departments”) announced they will temporarily not enforce their new standards published under the mental health parity Final Rule last fall. However, the earlier final rules and the statute itself remain in place and plan sponsors and fiduciaries should…

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Seyfarth Synopsis: Arkansas has become the first state in the nation to enact legislation, effective starting in 2026, prohibiting pharmacy benefit managers (PBMs) from owning or operating actual pharmacies within the state. We take a look at what that may mean for employers sponsoring health plans with pharmacy benefits in the state.

Background on PBMs Role in the Marketplace

PBMs have become a unifying scapegoat in the escalating concern about the cost of prescription drug coverage in the country. So, it becomes important to understand what role they really play. PBMs act as a middle man of sorts for the prescription drug coverage offered by many employer health benefit plans. With the ever-expanding universe of prescription drugs, including the many specialty drugs that are being offered and widely advertised to the public, it is difficult for plan sponsors to be able to directly manage this benefit. PBMs grew up as an answer to the needs for a third party to administer drug coverage under plans. 

Continue Reading Cutting Out the Middle Man
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Seyfarth Synopsis: On September 9, 2024, the Departments of the Treasury, Labor, and Health and Human Services (the “Departments”) released highly anticipated Final Rules under the Mental Health Parity and Addiction Equity Act (MHPAEA).  Instead of providing the guidance hoped for by stakeholders, the new rules may leave employers wondering if they should continue to…