Healthcare Cost Containment Insights

Prior Authorization, Post Promises: Will RFK Jr.’s Bet on Voluntary Reform Deliver?

On July 3, 2025
In a move that’s already generating buzz across the healthcare landscape, Health and Human Services Secretary Robert F. Kennedy, Jr. recently announced that the country’s largest health insurers have agreed to voluntarily streamline the controversial prior authorization process. It is a bold initiative aimed at reducing delays and denials that can prevent patients from receiving timely care. Major insurers including UnitedHealthcare, Aetna, Cigna, Blue Cross Blue Shield, Humana, and Kaiser Permanente have pledged to implement a range of reforms designed to make prior authorization more transparent, faster, and fairer.

Empowering Plans: P222 – SCOTUS Shockwaves: Analysis of June Decisions for Self-Funded Plans

On June 30, 2025
In this episode of Phia’s Empowering Plans Podcast, attorneys Nicholas Bonds, Esq. and Bryan M. Dunton, Esq., break down the key Supreme Court rulings issued in June 2025 that have direct implications for self-funded group health plans and their fiduciaries. From decisions impacting coverage mandates, nationwide injunctions, and gender-affirming care, Nick and Bryan explore how these opinions reshape the regulatory landscape and discuss practical takeaways for plan administrators and TPAs. Whether you’re updating plan language or keeping an eye out for compliance risks, this is an episode you can’t afford to skip.

Challenging the FDA: How Four States Are Pushing Back Against New Mifepristone Restrictions

On June 13, 2025
For a quarter century, Mifepristone, the medication used to block a hormone necessary for pregnancy development, has been widely used throughout America. If anything, over the past few years, since the Supreme Court overturned Roe vs. Wade and permitted individual states to outlaw abortions, the pill, used in conjunction with Misoprostol, has become even more popular among women seeking to terminate their pregnancies. And yet, despite its far-reaching popularity and well-documented efficacy, the Food and Drug Administration (FDA) has maintained stringent restrictions on Mifepristone.

ERISA Isn’t Always a Shield: The Limits of Fiduciary Preemption

On June 12, 2025
In the recently decided case of BlueCross BlueShield of Tennessee v. Nicolopoulos, the Sixth Circuit delivered a clear message to insurers and third-party administrators (TPAs) who also act as ERISA fiduciaries: ERISA’s broad preemption clause does not always provide immunity from state-level regulation. This case underscores the enduring significance of ERISA’s “savings clause,” especially when state regulators act against insurers in their more traditional role.

The ‘Piano Man’ Cancels Tour: Billy Joel Announces Rare Brain Condition

On June 5, 2025
For decades, Billy Joel has lit up stadiums across the globe, delighting fans with classic hits like “Only the Good Die Young,” “Uptown Girl,” and “Scenes From an Italian Restaurant.” People of all ages can recognize his songs with just a few notes on a piano. A musical icon since his debut in the early 1970s, Joel has won six Grammy Awards and has watched 43 of his songs make it to the Billboard Hot 100 chart.

Empowering Plans: P220 – Algorithms and Adjudication: How AI Is Affecting the Self-Funded Industry

On June 4, 2025
On the latest installment of the Empowering Plans podcast series, join attorneys Jon Jablon and Kendall Jackson as they discuss the integration of AI into the self-funded industry. From HIPAA considerations to current case law, this episode explores the impact of AI on health plans and TPAs thus far. It is an episode you can’t afford to miss!

Tiara Yachts v. BCBS Michigan: A Cautionary Tale

On May 29, 2025
When it comes to self-funded health plans, fiduciary duties often tend to lurk in the background – acknowledged and respected, but not always fully understood. The recent Sixth Circuit decision in Tiara Yachts, Inc. v. Blue Cross Blue Shield of Michigan brings those duties into sharp focus, offering a valuable lesson for TPAs, brokers, and plan sponsors.

Cunningham et. al. v. Cornell University: A Fascinating Interpretation of ERISA

On May 22, 2025
In what has been a very busy spring for the Supreme Court, it recently heard the case of Cunningham et. al. v. Cornell University, in which the plaintiffs, representing over 30,000 current and former employees enrolled in Cornell University’s 403(b) retirement plans (which contained approximately $3.4 billion in net assets), claimed that the plan fiduciaries violated ERISA by neglecting to remove low performing investments and engaging in prohibited transactions, namely paying excessive recordkeeping fees to retain two recordkeepers. While most of these claims had been dismissed by lower courts—the Second Circuit interpreted ERISA to mean plaintiffs were required to show that services were unnecessary or fees were unreasonable to state a claim—the plaintiffs ultimately prevailed as the high court, in a unanimous 9-0 ruling delivered by Justice Sotomayor, agreed to reverse the lower courts’ rulings.

Mental Health Parity Under Trump: Navigating Compliance in a New Era

On May 15, 2025
Review hundreds of health benefit plans, and it’s unlikely you’ll find one that is fully compliant with the Mental Health Parity and Addiction Equity Act (MHPAEA). It’s not that these plans are poorly constructed, it’s just that satisfying compliance requirements is incredibly challenging. Non-quantitative treatment limitations (NQTLs) present an incredibly challenging regulatory hurdle, amid an ever-shifting governing landscape. Given the enormous penalties that plans will incur for eschewing compliance, NQTL comparative analysis testing is a lifesaver. Join The Phia Group’s mental health parity professionals and learn from unrivaled experts as they share their experiences and learnings with you, right in the heart of Mental Health Awareness Month. We break down the latest regulations and discuss cost containment options, not to mention the social impact of these issues. Plus, we explored the latest breaking development: President Trump’s executive order to cap all prescription drug prices, and what this could mean for your plan. This is one webinar you truly cannot afford to miss.

Empowering Plans: P218 – Unreasonable Plan Fees on Trial: Cunningham v. Cornell University

On May 8, 2025
In this episode, we unpack the Supreme Court’s unanimous decision in Cunningham v. Cornell University — a landmark ERISA case with major implications for retirement and health plan fiduciaries. We explain the facts behind the case, what “prohibited transactions” really mean, and why the Court's ruling on affirmative defenses matters. If your health plan pays fees to TPAs, PBMs, IDR vendors, or brokers, this episode is for you.

Eggs, housing, . . . and healthcare? A new survey found that healthcare has never been so unaffordable for Americans this decade

On May 2, 2025
Not even a month ago, on April 4, the results of the West Health and Gallup poll survey, conducted from mid-November to late December last year, were published, revealing that quality, affordable healthcare eludes 35 percent of Americans (representing some 91 million adults), a four-point jump from 2023 and the highest mark since 2021. Meanwhile, approximately 29 million Americans, or 11% of those surveyed, reported that they lacked the means to afford medication and care as recently as over the past three months. Just as unnerving—but most certainly not surprising—is that the disheartening trend has been most prominent among lower-income individuals (those who belong to families earning less than $24,000 per year) as well as Hispanic and Black Americans; conversely, there has been negligible change in this regard among mid- to high-income earners and whites. Hence, one reason why there is the ever-widening healthcare social disparity plaguing our nation.

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Prior Authorization, Post Promises: Will RFK Jr.’s Bet on Voluntary Reform Deliver?

The Patent Fumble That Could Bring Down the Cost of Weight Loss Drugs