During a recent hearing held by a House subcommittee, employers asserted that pharmacy benefit managers (PBMs) should be obligated to act as fiduciaries. Their argument centers on the idea that this would ensure PBMs prioritize the interests of health plan beneficiaries when providing benefits and administrating plan expenses. This development is of paramount importance to corporations, law firms, and plan beneficiaries.
Three primary PBMs, namely CVS Health, Optum RX, and Express Scripts, have a majority stake in the market share for self-insured health plans. These powerful actors have an essential role in controlling the range of prescription drugs covered by health plan formularies, as well as the price rebates on these drugs, according to Russell DuBose, vice president of human resources for Tuscaloosa, Alabama-based manufacturer Phifer Inc. DuBose made these remarks during his testimony to the health subcommittee of the House Committee on Education & the Workforce.
Although some state-led efforts push back on PBMs, employers and Republicans largely oppose these initiatives. An employee-driven incentive to advocate for better long-term disability benefits with a focus on behavioral health also builds momentum in parallel.
This ongoing debate about the role of PBMs in managing health plan expenses and benefits raises critical questions about fiduciary duty within the healthcare sphere. Putting PBMs in a fiduciary role could instigate significant changes to the ways in which these entities operate and interact with other players in the health care realm.
More details of the hearing can be found in the live feed of the event on the House Committee on Education & the Workforce’s official site here. Additional insight and detailed coverage can also be tracked on the original article on Bloomberg Law.