News/Blogs

Regulatory Trends Q&A Highlights

• Reimbursement Laws & Self-Funded Plans:
  Affect pass-through contracts most directly; PBMs and plans will need to adapt to NADAC-based rules.
• Creditable Coverage & HDHPs:
  High-deductible plans may fall short of the 72% threshold; design tweaks may be required.
• Machine-Readable File Compliance:
  Serve You Rx will support clients by generating required files and guidance.
• Choosing Between 60% vs. 72% Tests:
  Plans meeting 72% should adopt it early; others can maintain 60% until 2027 transition.
• State Law Applicability to ERISA Plans:
  Plans should review statutory exemptions, state court precedents, and general ERISA preemption standards; Serve You Rx offers compliance support without giving legal advice.

Key Takeaways for Benefit Professionals

• State activity dominates PBM reform — stay alert to multi-state compliance implications.
• Federal regulators are tightening oversight — from disclosure to transparency mandates.
• ERISA preemption boundaries remain fluid — expect ongoing litigation.
• Creditable coverage and transparency rules require early 2026–2027 preparation.
• Serve You Rx supports clients proactively — translating policy into action to maintain compliance, affordability, and member-first outcomes.

Take the Next Step 

If you’d like to partner with a PBM backed by compliance expertice, reach out to us at Sales@ServeYouRx.com or fill out the form below.

About Serve You Rx®   
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what’s best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for nearly 40 years, Serve You Rx can implement new groups in 30 days or less and say “yes” to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.