Schedule

• Key legal developments in 2025 and early 2026
• Major trends and the outlook for 2026 and beyond

• PBM Landscape and Why Change Is Needed: Overview of traditional PBM models, key market pressures, and the growing business case for alternative approaches
• Core Risks in Traditional PBM Arrangements: Spread pricing, rebate retention, formulary incentives, pharmacy steering, DIR fees, and data transparency concerns
• Legal and Regulatory Developments: Federal and state enforcement trends, key litigation, and emerging disclosure requirements shaping PBM oversight and contracting
• Emerging Alternatives and Cost Containment Models: Transparent PBMs, pass-through pricing, carve-outs, direct contracting, and value-based strategies to reduce drug spend
• Practical Contracting and Compliance Strategies: How to evaluate alternatives, strengthen contract terms, ensure data access and transparency, and mitigate fiduciary and compliance risk

As drug pricing remains a top policy and industry concern, 2026 is shaping up to be a pivotal year for change. This presentation will explore the evolving prescription drug pricing landscape, with a focus on TrumpRx, PBM reform, and other key policy, regulatory, and market developments expected to shape costs and access in the year ahead. Panelists will examine how federal and state initiatives, payer and manufacturer strategies, and broader political dynamics may influence pricing, reimbursement, and patient affordability. Attendees will gain insights into how these proposals compare with existing reforms and what they may mean for manufacturers, payers, providers, and patients in the year ahead.

• An overview of TrumpRx and its potential impact on drug pricing
• Federal and state PBM reform and transparency initiatives
• Other major drug pricing proposals and regulatory developments
• Implications for manufacturers, payers, providers, and patients
• Market trends implementation considerations, and issues to watch in the year ahead/li>

• Overview of long-standing regulatory scrutiny of insurance producers
• Legislative and regulatory efforts to increase oversight and regulation of producer activities and compensation
• Impact on the health insurance market, including Medicare Advantage, Medicare Part D, and Affordable Care Act Health Insurance Exchange markets
• Assessment of key compliance risks that for insurers, producers, and other third-party marketers

• Plan sponsors have always been targets for fiduciary breach litigation, but never more so than now. For years, the plaintiffs' bar has aggressively targeted the sponsors of 401(k) plans, and their successes on the retirement front have encouraged them to seek new targets: sponsors of health care plans and their insurance brokers and consultants. This 60-minute panel will examine the next wave of "hot" (and rapidly developing) litigation, including:
• The Supreme Court's decision in Cunningham v. Cornell University, and its implications for defending prohibited transaction claims
• The Trump Administration's proposed investment safe harbor
• The new wave of health plan litigation and its current status, including litigation against:
• Brokers
• Plan sponsors for "excessive premiums and cost-sharing" involving PBM arrangements
• Universities for allegedly excessive premiums of PPO options as compared to value of other benefits offered under plans
• Plan sponsors, brokers and consultants involving "voluntary benefits insurance" and allegedly excessive premiums attributable to commissions paid to brokers

As part of this presentation, we will provide practical, real-world examples that will help manage everyday managed care contracting and compliance dilemmas. We'll present at 4-5 hypotheticals that implicate common issues that arise as part of the complex relationship and interaction between payors, providers and downstream entities, including dispute resolution provisions, compliance attestations, overpayment obligations, etc. We will reference helpful tips, checklists and best practices, including from the AHLA Managed Care Contracting Toolkit made available to PPMC.

• No Surprises Act & IDR Arbitration Litigation Continues to Surge
• Medicare Advantage Risk Adjustment & False Claims Act Enforcement
• Challenges to FCA Qui Tam Structure & Administrative Deference
• Medicaid Managed Care: Program Integrity, Eligibility, and Rate Disputes
• Payor/Provider Litigation

Federal and state governments have sought to support and regulate the use of artificial intelligence and machine learning tools in health insurance operations. This session will provide a practical overview of how health insurers are utilizing these tools in their operations (from back-office functions to claims administration) and will examine the impact of relevant federal and state legislation and guidance impacting AI use. In addition, this session will examine safeguards insurers are implementing to maintain compliance with applicable laws.