Broker Regulation

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.

"As the largest employer in the world, Amazon makes clear that it does not believe the law applies to it and that they are free to treat their employees how they see fit. The law does not support this belief," the plaintiff said in a court filing.

If you track the revenue of UnitedHealth, Cigna, Aetna/CVSHealth, Anthem/Elevance, and the Blues combined, you'll see that as their revenue goes up, so do the premiums charged to employers and employees.