Your PBM’s Books are Opening. Your Fiduciary Duty Just Increased.
Your PBM’s books are opening. Your fiduciary duty just increased.
The Consolidated Appropriations Act turned your health plan into a fiduciary question, not just a benefits line. If your company pays its employees’ health claims itself, the people who run that plan are legally responsible for spending that money wisely, the same way a pension trustee is responsible for the retirement fund.
The law spells out what that means in practice:
Every year, employers must attest that no contract keeps them from their own claims data. If an insurer, administrator or PBM says the data belongs to them, that clause is now illegal.
Brokers and consultants must disclose what they’re paid, including commissions and bonuses that used to be invisible.
Every year, plans must report what they spend on prescription drugs, and which drugs drive the cost.
And under the law, a plan may only pay reasonable fees. Paying more than a service is worth is not just wasteful; it can be a breach of duty.
The new PBM disclosure rule adds the missing piece: what the PBM itself takes. PBMs decide which drugs your plan covers, what pharmacies get paid, and how much of the rebate money ever comes back to you. Until now, most employers had no way to see that spread.
Employees have noticed. Workers at large employers, Johnson & Johnson and Wells Fargo among them, have sued, saying their plans overpaid for drugs and the extra came out of their own paychecks and premiums. The early cases were dismissed on technical grounds, but the question they raised hasn’t gone away: did anyone check?
Here is the catch. The law doesn’t read the reports for you. A plan sponsor who receives the data and never checks it is in a weaker spot than one who never had it. Once the numbers are on your desk, “we didn’t know” stops being a defense.
PHCC gives employers that process: independent analytics on their own claims that show where the money goes, how drug spend compares with what it should cost, the quality of care their people get, and what to change. Because we work for the employer, not the PBM or the insurer, our only job is to tell you the truth about your own plan. The result is a documented review every year that a board can stand behind, and a plan that spends its money on care that actually keeps people well.
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© 2026 William H Bestermann Jr MD
3 Amsterdam Lane, Simpsonville, SC 29681