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Jessamyn Vedro

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Jessamyn is a partner in the firm’s Consumer Financial Services practice, based in Los Angeles. She focuses her practice on the health insurance and managed health care sectors. Jessamyn represents major health plans and insurers in complex litigation in both state and federal courts, including actions for breach of contract, bad faith denial of benefits, ERISA benefits, and unfair competition, among others, with particular emphasis on out-of-network provider reimbursement disputes.

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On September 8, the Department of Labor’s Employee Benefits Security Administration (EBSA) issued Field Assistance Bulletin No. 2026-03, outlining how it will enforce the Mental Health Parity and Addiction Equity Act’s (MHPAEA) nonquantitative treatment limitation (NQTL) requirements going forward. The bulletin follows through on EBSA’s January 2026 announcement identifying mental health/substance use disorder (MH/SUD) benefit barriers as a national enforcement priority, and responds to sustained industry complaints that prior NQTL enforcement and comparative analyses requirements created confusion and unnecessary compliance burdens.

In a significant en banc decision issued on August 11, 2026, the U.S. Court of Appeals for the Fifth Circuit largely affirmed a district court ruling that invalidated key portions of the federal agencies’ rules governing the calculation of the “qualifying payment amount” (QPA) under the No Surprises Act (NSA). The court’s decision has major implications for how insurers calculate the benchmark rate at the center of the NSA’s independent dispute resolution (IDR) process.

Recently, the Sixth Circuit issued a significant ERISA preemption ruling for employers and pharmacy benefit managers (PBMs). The court held that Tennessee’s PBM laws, which require “any willing” pharmacy access and limiting incentives that steer members to plan‑favored pharmacies, are preempted as applied to self‑funded ERISA plans. The ruling draws a clear line between permissible PBM cost regulation and impermissible interference with plan design and administration.

The Fourth Circuit has affirmed a preliminary injunction barring enforcement of West Virginia’s S.B. 325, which sought to restrict how drug manufacturers implement contract pharmacy policies under the federal 340B Drug Pricing Program. In a published decision, the court held that manufacturers are likely to succeed on their claim that S.B. 325 is preempted because it impermissibly rewrites the “bargain” Congress struck with manufacturers under its spending power and interferes with the Health and Human Services’ (HHS) exclusive enforcement role.

In our January 14 blog, we explained that Chief Judge Lance Walker of the U.S. District Court for the District of Maine had entered a nationwide preliminary injunction in American Hospital Association v. Kennedy, blocking the Health Resources and Services Administration’s (HRSA) 340B Rebate Model Pilot Program under the Administrative Procedure Act (APA). We also noted that both the district court and the First Circuit denied the government’s requests for a stay, and that the U.S. Department of Justice (DOJ) told the First Circuit the parties planned to dismiss the appeal and consider sending the approvals back to HRSA.

In an unpublished memorandum decision, the Ninth Circuit in R.R. v. California Physicians’ Service d/b/a Blue Shield of California, affirmed the insurer and administrator’s denial of benefits for a dependent’s residential mental health treatment under an ERISA‑governed plan. The court applied abuse‑of‑discretion review and concluded that the denial was supported by the plan’s medical‑necessity criteria and the administrative record. The dissent, however, argued that the majority failed to meaningfully account for a structural conflict of interest and for the administrator’s handling of treating‑provider evidence and prior failed lower levels of care.

On January 7, the U.S. Court of Appeals for the First Circuit denied the federal government’s request for a stay of the nationwide preliminary injunction barring implementation of the Health Resources and Services Administration’s (HRSA) 340B Rebate Model Pilot Program. Five days later, on January 12, the Department of Justice advised the court that the parties are discussing returning the challenged approvals to HRSA for reconsideration and that they “plan to dismiss the appeal in short order,” signaling that the current version of the pilot is unlikely to move forward on appeal.

On January 12, the U.S. Supreme Court denied the petition for writ of certiorari in Guardian Flight, leaving in place the Fifth Circuit’s June 2025 decision that we covered in our prior post (available here). As a result, within the Fifth Circuit, providers cannot rely on the No Surprises Act (NSA) itself to enforce Independent Dispute Resolution (IDR) awards in court and face a heightened standing bar for ERISA-based claims where patients are insulated from financial harm. And the persuasive effect of the Fifth Circuit’s holding is bolstered nationwide.

On December 29, 2025, Chief Judge Lance Walker of the U.S. District Court for the District of Maine granted the plaintiffs’ motion for a preliminary injunction in American Hospital Association v. Kennedy. The court enjoined implementation of HRSA’s 340B Rebate Model Pilot Program “pending further order,” blocking the program from going into effect on January 1, 2026 (and April 1, 2026 for one manufacturer).

On November 24, the Ninth Circuit issued an unpublished memorandum disposition in Dedicato Treatment Center, Inc. v. Aetna Life Insurance Co., affirming dismissal of an out-of-network provider’s state-law claims as preempted by ERISA’s remedial scheme. The panel’s brief decision underscores that the Court’s 2024 decision in Bristol Holdings (discussed here) applies broadly to state-law causes of action arising from pre-service verification-of-benefits and authorization communications, even where a provider also pleads an alternative ERISA benefits claim pursuant to an assignment of benefits from the member. Although not precedential under Ninth Circuit Rule 36-3, the disposition is a clear, persuasive affirmation of Bristol’s reach.