PBMs under scrutiny: How accountability and fiduciary standards can improve healthcare for all

A recent hearing before a House subcommittee has brought attention to the need for pharmacy benefit managers (PBMs) to be held to a higher standard as fiduciaries. This means that PBMs, such as CVS Health, Optum RX, and Express Scripts, should prioritize the best interests of health plan beneficiaries by providing necessary benefits and managing plan expenses in a way that benefits those covered by the plans.

Russell DuBose, the vice president of human resources at Phifer Inc., a manufacturer based in Tuscaloosa, Alabama, spoke at the hearing and highlighted the significant influence that PBMs have in shaping plan formularies and negotiating drug prices. He emphasized the need for greater transparency and accountability in the operations of PBMs to ensure that they act in the best interests of those they serve.

The House subcommittee’s discussion shed light on the complex dynamics of PBM operations and their implications for health plan beneficiaries. By requiring PBMs to act as fiduciaries, there is an opportunity to enhance oversight and regulation of their activities. This could lead to improved access to affordable prescription drugs and better quality care for individuals enrolled in health plans.

As the debate continues on how to regulate PBMs, it is clear that ensuring their accountability and adherence to fiduciary standards is essential for promoting the well-being of health plan beneficiaries. The market share monopolized by these PBMs must be addressed to ensure fairness and equitable treatment for all health plan members.