We recently caught up with Nick Karls, director of compliance at Holmes Murphy and Associates, and Nathan Cassin, pharmacy benefits consulting director, to discuss fiduciary responsibilities, PBM contracts, and litigation risks.
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How can brokers help employers mitigate risks related to their Pharmacy Benefit Management (PBM) contracts? 

Brokers and consultants can assist employers in mitigating risks by thoroughly reviewing their PBM partners, contracts, and clinical program strategies to identify current and future issues relating to pricing transparency, rebate structures, and formulary management. Another solution is for brokers to help employers evaluate terms and ensure contract language aligns with fiduciary standards. 
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What fiduciary responsibilities do employers need to be aware of when managing prescription drug benefits?

The main fiduciary responsibility that an employer needs to be aware of when managing their prescription drug plan is the duty of prudence. They want to be able to show that they are carefully evaluating their PBM options, using that evaluation to select the best PBM for their plan, and finally that they’re monitoring the PBM they selected. It is not a “set-it-and-forget-it” situation; employers need to stay involved from start to finish. 
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What steps can fully insured and self-insured plans take to reduce litigation risks?

Steps that these types of plans can take to reduce litigation risks begin with thoroughly reviewing all contracts to identify potential savings and ensure optimal terms. Regular monitoring of pricing trends, fee structures, and plan performance helps organizations stay ahead of cost increases and negotiate better rates when necessary.