Broker Regulation

Rebates granted by pharmaceutical manufacturers to insurers reduce the actual prices paid by insurers, causing the true prices of prescriptions to diverge from official statistics.

The draft rule would require providers to check all 50 states' prescription drug monitoring programs before prescribing a controlled substance to a patient whom they have not seen before in person.

The three largest PBMs, including CVS Caremark, Express Scripts and OptumRx, "handle 79% of U.S. medical prescriptions for approximately 270 million people."

On average, Marketplace enrollees had access to 40% of the doctors near their home through their plan's network, with considerable variation around the average.

The DOL earlier this year filed a lawsuit accusing Blue Cross and Blue Shield of Minnesota of incorrectly imposing a state provider tax on self-funded health plan customers and violating its fiduciary duties under ERISA.

It's critical that employers and their benefits advisors take the fiduciary standards learned from retirement plans and apply them to their health plans.