The Biggest PBM Transparency Rule in Decades? DOL Crackdown on Rebates, Spread Pricing & Hidden Fees

Описание: In Episode 2 of The EOB Podcast, Justin Leader and Julie Selesnick break down the proposed U.S. Department of Labor rule that could become the most consequential PBM transparency regulation in decades.

The proposed rule would require Pharmacy Benefit Managers (PBMs) to provide detailed disclosure of:

• Manufacturer rebates
• Spread pricing practices
• Pharmacy clawbacks
• Indirect compensation
• Affiliate & GPO relationships
• Audit rights and verification standards

But here’s the key: PBMs are already subject to compensation disclosure requirements under ERISA Section 408(b)(2) and the Consolidated Appropriations Act (CAA) of 2021. So what makes this new rule different?

Justin and Julie explain:

Why employers cannot delegate fiduciary responsibility
How rebate retention clauses can cost millions
The impact of pharmacy clawbacks on independent pharmacies
Why spread pricing is still a major issue
What plan sponsors should be asking for in their RFPs right now
Why you don’t need to wait for the rule to pass to demand transparency

If you are an employer, HR leader, CFO, broker, consultant, fiduciary, or compliance professional, this episode gives you a practical roadmap for reducing PBM risk and protecting your health plan.

You don’t need a new law to start being proactive.

Subscribe for more episodes breaking down healthcare benefits, ERISA compliance, fiduciary risk, PBM reform, and employer health plan strategy.

🎬 YouTube Chapters

00:26 – Introduction: The Proposed DOL PBM Transparency Rule
Why this may be the most consequential PBM rule in decades.

01:09 – PBMs Already Have Disclosure Obligations (408b2 & CAA)
Why this rule isn’t starting from zero.

03:28 – Why Employers Struggle to Access Their Own Data
RDC reporting frustrations and carrier resistance.

06:17 – Will This Rule Actually Move the Needle?
Enforcement, litigation, and accountability.

08:24 – Public Sentiment & Political Pressure on PBMs
Why the timing matters right now.

10:27 – What Employers Should Require in Their RFPs
Practical steps plan sponsors can take immediately.

12:22 – Rebate Retention Clauses & Hidden Contract Traps
How millions can be forfeited at contract termination.

14:20 – PBMs as the First Domino in Healthcare Reform
Why PBM reform may trigger broader change.

16:15 – You Don’t Need a New Law to Fix This
Transparent PBMs already exist.

17:05 – Section 1: Required Disclosure of PBM Services
Formulary management, claims administration & fiduciary status.

19:18 – Section 2: Direct Compensation Disclosure Requirements
PMPM fees, admin fees, commissions.

20:18 – Manufacturer Rebates & Indirect Compensation
Tracking money from drug manufacturers.

21:11 – Pharmacy Clawbacks & Copay Overcharges
How PBMs extract additional revenue.

25:09 – Spread Pricing Explained
How pricing differences are calculated and retained.

26:15 – Affiliate & GPO Disclosure Requirements
Offshore entities, rebate aggregators, ownership structures.

28:39 – Audit Rights & Verification Standards
“Trust but verify” for plan sponsors.

31:05 – Safe Harbors & Employer Liability Risk
What happens if disclosures aren’t provided.

33:38 – Enforcement & Why Plan Sponsors Must Be Proactive
Why waiting is risky.

36:21 – Final Takeaway: You Don’t Need the Rule to Act Now
How employers can demand transparency immediately.

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