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Pharmacy Benefit Managers (PBMs): What ERISA Fiduciary Obligations and Duties Relate to Prescription Drug Plans?

Trucker Huss

Mar. 5, 2024
1:00 p.m. - 2:00 p.m. ET

Presenters: Mary Powell

Prescription drug costs keep escalating. What is driving these high costs? Pharmacy Benefit Managers (PBMs) are a large part of the problem.  Understanding where PBMs fit into the drug pricing puzzle is a key issue for plan fiduciaries.  This is highlighted in a recent complaint filed against Johnson & Johnson by an employee who claimed that defendants (the company and its benefits committee) breached their fiduciary duties due to the mismanagement of the PBM for the health plans.

The following will be discussed:

  • An explanation of PBMs
  • Basic concepts of how PBMs make money from health plans
  • Fiduciary obligations related to PBM contracts and services
  • How to read and negotiate a PBM contract
  • How the new transparency rules under the Affordable Care Act and the Consolidated Appropriations Act provide tools for employers to negotiate PBM contracts
  • Recent case law regarding PBMs

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