Cost-Containment

EBSA said the $1.4 billion returned to plans, participants and beneficiaries represents a slight increase from the $1.384 billion recovered in fiscal year 2024.

Although it was expected to go live in late January, HHS Secretary Robert F. Kennedy Jr. announced at a cabinet meeting last week that it instead "is going to be happening sometime, probably in the next 10 days."

West Virginia began to license PBMs in 2020. In 2022, the state began to require insurers to pass all prescription drug rebates and other prescription drug discounts on to health insurance purchasers in 2022.

An Aon health benefits specialist predicts that employers will have to work harder to monitor their pharmacy benefit managers.

The average allowed amount for a patient with no chronic conditions was $1,590, while the average allowed amount for a patient with one chronic condition was nearly double, at $3,039.

"Employers have an opportunity to strengthen engagement by pairing competitive benefits with greater flexibility and support that helps people feel more secure," said Jake Spiegel, senior research associate at EBRI.