Prescription drug costs have become one of the fastest-growing expenses in employer-sponsored health plans. Yet despite representing a significant portion of overall healthcare spending, pharmacy benefits remain one of the least understood components of a health plan.
In 2012 an “antitrust” class action suit was filed against the Nation’s 36 Blue Cross plans, alleging the Blue Cross Association rules prevented fair competition. In the Fall of 2020, there was a “proposed” settlement of $2.7 Billion dollars that would distribute dollars back to Blue Cross customers that had policies between 2/07/2008 and 10/16/2020. The Blue Cross and Blue Shield Association, in partnership with the “local” Blue Cross plan(s) & the settlement administrator gave notice to eligible employer groups (and some individual employees) information about the proposed settlement and how they can register as a member of the class. Eligible employers had a deadline of November 2021 to register/file a claim as a member of the class, and the past 5 years have shown a number of delays & appeals.
Starting June 1, 2026, Illinois employers will need to navigate a new leave requirement under the Family Neonatal Intensive Care Leave Act. This law requires certain employers to provide unpaid leave to employees whose child is receiving care in a neonatal intensive care unit (NICU).
At a high level, the law reflects a growing focus on supporting employees during critical and often unexpected life events. At the same time, it introduces additional compliance responsibilities that employers will need to manage carefully.
It's getting noisy over here. Diary of a CEO ran a 90-minute peptide episode that went viral. HHS reversed the FDA ban on most of the restricted peptide list. The wellness industry began its pivot years ago. Your CFO's group chat is asking what BPC-157 is.
Most employers spend more on employee benefits every year. Costs go up. Complexity goes up. But outcomes? They stay flat.
Most private business owners have some version of a succession plan. A buy-sell agreement drafted years ago. A vague understanding that the life insurance policy covers it. A handshake with a partner about what happens if one of them walks away.
What most owners don't have is a plan that reflects the business as it exists today.
That gap is where things get expensive.
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ICHRA: What Is It?
An Individual Coverage Health Reimbursement Arrangement differs from a traditional group health plan by shifting how coverage is provided. Instead of sponsoring a group policy, the employer offers a defined contribution that employees use to purchase their own individual health insurance. Working with a plan administrator, employees can choose from multiple insurers and plan options, and their share of the premium is typically paid pre-tax through payroll. For some employers, this approach can be more cost-effective and predictable than maintaining a group plan.
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For most education leaders, employer-sponsored healthcare has long been treated as a fixed part of doing business.
You select a carrier.
You negotiate a renewal.
You absorb the increase.
You explain it to employees.
You repeat the process the following year.
Overview of the New Requirement
Illinois House Bill 1697 introduces a new annual fee tied to prescription drug benefits, and many employers will begin seeing this charge in 2026. Most Blue Cross Blue Shield of Illinois (BCBS of IL) health plans use BCBS of IL’s subsidiary, Prime Therapeutics, as its pharmacy benefit manager (PBM), and this update applies directly to those plans. Under the Prescription Drug Affordability Act, PBMs are required to pay the State of Illinois fifteen dollars per covered individual who is enrolled in pharmacy benefits and lives in Illinois. This includes both employees and dependents. BCBS of IL & Prime Therapeutics will pay the fee to the state fund, and BCBS of IL will pass the cost through to employer groups that fall under the law.
The IRS has announced new inflation-adjusted limits for flexible spending accounts (FSAs) beginning in 2026, giving employees more room to set aside pre-tax dollars for medical and dependent care expenses. These updates, along with a major legislative change from the One Big Beautiful Bill (OBBB) Act, make 2026 an important year for benefit planning. For employees, these changes translate to greater flexibility and potential tax savings. For employers, they mean updated plan limits, new communication needs, and an opportunity to highlight valuable benefits.