PBM Problems (Part 1): Who do Brokers and Consultants Really Work for? Risks for Plan Sponsors w/ ERISA attorney Paul Holmes

This episode is a must-listen for all plan sponsors and employers!  “In American business you don’t expect your major vendors to be profit-gouging you, and you don’t expect these major consulting firms to be taking their side instead of yours.” – Paul Holmes  As Pharmacy Benefit Managers (PBMs) face mounting scrutiny from policymakers and the public, health plan fiduciaries can’t ignore the money flows and potential conflicts-of-interest that may be hiding in the pharmacy benefit contracting process.  In this episode, the MTVA Board talks with ERISA attorney Paul Holmes of Williams, Barber, Morel about the perverse incentives and lack of transparency in PBM contracts. Tune in to learn what plan sponsors need to ask their brokers and consultants and how to comply with new requirements in the Consolidated Appropriations Act (CAA). Holmes also discusses some innovative approaches – like carve-outs for specialty pharmacy and prior authorization – for plan sponsors to consider.  This is the first episode in a new series from the “MTVA Unscripted” podcast called “PBM Problems” – exploring the middlemen who drive wasteful drug spending and pocket the profits.  Resources mentioned in the episode: Dr. Eric Bricker’s videos on PBMs: PBMs Explained - Learn how the money flows and 5 PBM Tricks in 1 Training Session MTVA Unscripted episode on the Johnson&Johnson lawsuit MTVA Unscripted episode w/ Dr. Scott Conard All episodes of MTVA Unscripted can be found ⁠here⁠. We’re grateful to Southern New England Healthcare Organization (SoNE Health) for their continued partnership and support as a sponsor of the Moving to Value Alliance. You can help advance our mission with a tax-deductible contribution at https://www.movingtovalue.org/jointhemovetovalue.