Employers Urge Congress to Designate PBMs as Health Plan Fiduciaries

During a House subcommittee hearing, it was suggested that pharmacy benefit managers (PBMs) should be required to act as fiduciaries, prioritizing the best interests of health-plan beneficiaries by providing benefits and paying plan expenses. The hearing highlighted concerns about three major PBMs – CVS Health, Optum RX, and Express Scripts – which have a significant market share for self-insured health plans. These PBMs have significant control over the prescription drugs covered on health plan formularies and the price rebates on those drugs.

Russell DuBose, the vice president of human resources at Phifer Inc., a manufacturer based in Tuscaloosa, Alabama, raised these concerns at the hearing. According to DuBose and other speakers, the dominance of these PBMs in the market raises questions about their impartiality and their ability to act solely in the interests of health-plan beneficiaries.

The issue of transparency and accountability in PBM operations was also discussed during the hearing. Some participants argued that greater oversight and regulation of PBMs is necessary to ensure that they are acting ethically and in the best interests of those they serve.

Overall, the hearing shed light on the growing concerns about the influence and power of PBMs in the healthcare system. Moving forward, there may be a need for increased regulation and oversight to ensure that PBMs are fulfilling their responsibilities as fiduciaries and acting in the best interests of health-plan beneficiaries.