The Biggest PBM Transparency Rule in Decades? DOL Crackdown on Rebates, Spread Pricing & Hidden Fees

Transcript

In Episode 2 of The EOB Podcast, Justin Leader and Julie Selesnick break down the proposed U.S. Department of Labor rule that could become the most consequential PBM transparency regulation in decades. The proposed rule would require Pharmacy Benefit Managers (PBMs) to provide detailed disclosure of:

• Manufacturer rebates

• Spread pricing practices

• Pharmacy clawbacks

• Indirect compensation

• Affiliate & GPO relationships

• Audit rights and verification standards

But here’s the key: PBMs are already subject to compensation disclosure requirements under ERISA Section 408(b)(2) and the Consolidated Appropriations Act (CAA) of 2021.

So what makes this new rule different? Justin and Julie explain:

• Why employers cannot delegate fiduciary responsibility
• How rebate retention clauses can cost millions
• The impact of pharmacy clawbacks on independent pharmacies
• Why spread pricing is still a major issue
• What plan sponsors should be asking for in their RFPs right now
• Why you don’t need to wait for the rule to pass to demand transparency

If you are an employer, HR leader, CFO, broker, consultant, fiduciary, or compliance professional, this episode gives you a practical roadmap for reducing PBM risk and protecting your health plan. You don’t need a new law to start being proactive. Follow for more episodes breaking down healthcare benefits, ERISA compliance, fiduciary risk, PBM reform, and employer health plan strategy.

Source: https://eobpodcast.com