Pharmacy Benefit Manager Contracting for Fully Insured and Self-Funded Group Plans

BARBRI

This CLE course will provide employee benefits counsel guidance on applicable rules and recent legislative developments on pharmacy benefit manager (PBM) contracting and offer strategies for negotiating and drafting PBM agreements for employee health plans. The panel will discuss the impact of the One Big Beautiful Bill Act (OBBBA) and other recent legislation, how to maximize prescription coverage savings, and how to draft agreements that guarantee transparency and plan sponsor oversight and avoid hidden fees.

Description

Prescription drug expenses have increased more than any other healthcare category over the past 10 years. PBMs can help employers with self-funded plans control prescription costs, but PBM contracts must be carefully negotiated and drafted to protect the plan sponsor's—rather than the PBM's—interests.

OBBBA provides a few provisions aimed at PBMs but proposed legislation for significant reform is pending to further transparency, fees, and other key items. Counsel must thoroughly understand the complexities of prescription drug pricing and PBM contracting to control costs, avoid hidden fees, and maximize prescription drug benefit performance.

Listen as our authoritative panel discusses recent developments for PBMs and offers strategies for negotiating and drafting PBM contracts. The panel will discuss how to maximize prescription coverage savings, draft agreements that guarantee transparency and plan sponsor oversight, and avoid hidden fees.

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