AH102 - PBM Reform Update: Health Policy Changes Slowly, Until it Doesn't, with Lloyd Fiorini

On this episode of Astonishing Healthcare, Lloyd Fiorini, General Counsel & Chief Compliance Officer at Judi Health, returns to the studio for a discussion about the barrage of regulatory changes shaping the pharmacy benefit manager (PBM) landscape in early 2026. Within just two weeks, the Department of Labor announced new proposed PBM rules, the Consolidated Appropriations Act of 2026 (CAA 2026) became law, and the FTC announced a settlement with Express Scripts. Then, to top it all off, TrumpRx went live.Lloyd offers clear, helpful explanations of the key takeaways from each of these concurrent reforms aimed at improving transparency and how PBMs operate and interact with the other stakeholders in the supply chain, from independent pharmacies to patients and plan sponsors (employers). Whether you're responsible for a self-funded plan or overseeing a Medicare Part D plan, this episode provides the detail and insights about where the puck is going that you need. As Lloyd said, "I think we've made a great step forward, but the work isn't done."It's also worth giving a shoutout to previous guest Jim Winkler, as "Change is Imminent" is in the title of AH090!Episode HighlightsThe Department of Labor’s historic proposed rules on PBM disclosures fills a gap left by the CAA of 2021The CAA 2026 redefines the financial alignment of pharmacy benefits beyond just Medicare Part Patient/plan member protection seems to be what the FTC’s recent settlement was all aboutTrumpRx signals a broader shift toward transparent, cost-plus pricing models, but it's just for cash-paying customers, at least for nowDelinking and efforts to block vertical integration are hotly contestedRelated ContentAH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing HealthcareHow to obtain Rx data and what to do with itAH096 - A Quick Government Programs Update: The IRA & MPPP, Managing D-SNPs, and More, with Jason BarrettoSigns it is time to change your PBM vendor, and how to overcome common hesitationsReference LinksUS Department of Labor proposes historic pharmacy benefit manager fee disclosure rule (January 29)PBM Reforms Signed Into Law, Reshaping Medicare Part D Drug Pricing Transparency (February 3)FTC Secures Landmark Settlement with Express Scripts to Lower Drug Costs for American Patients (February 4)TrumpRx Launches (February 6)For more information about Judi Health and this episode, please visit Judi Health - Insights.