For most of my career, a self-funded employer could pay every claim and still be told it could not see the claims file. The reason was a gag clause: a line in the TPA, PBM, or network contract that kept the plan from getting or sharing its own cost, quality, and claims data.

If your organization offers group health coverage and you've received an IRS Letter 226-J, you're not alone — and it doesn't automatically mean you owe a penalty.

How Strategic Prescription Management Can Deliver Measurable Savings for Employers

GLP-1 medications like Ozempic®, Wegovy®, Zepbound®, and Mounjaro® are transforming diabetes care, weight management, and cardiovascular health. But as employees near retirement, many are asking: Will Medicare cover my GLP-1 medication?

The answer depends on the diagnosis. While Medicare currently covers these drugs for Type 2 diabetes and certain FDA-approved cardiovascular conditions, it generally does not cover them for weight loss alone.

In this article, Marsha C. Marrullier, REBC, breaks down the current coverage rules, why the policy is evolving, and practical steps HR leaders can take today to help employees avoid costly surprises during the transition to Medicare.