As health plan sponsors prepare for 2026 open enrollment, they face familiar concerns of rising claims trends and labor costs, while also confronting new ERISA litigation risks tied to pharmacy benefit manager (PBM) contracts. A consistent theme runs through these challenges: Increasing and opaque costs charged by vendors that must ultimately be borne by employers and employees.
Three recent ERISA cases have alleged that plan sponsors breached fiduciary duty in the management and design of prescription drug benefit contracts. In Lewandowski v. Johnson & Johnson, Knudsen v. MetLife Group and Navarro v. Wells Fargo, plan participants asserted that fiduciaries failed to ensure prescription drug prices under health benefit plans were reasonable.
