As if HR wasn’t already hard enough…Mark Cuban is fond of emphasizing that if you’re a self-insured employer, you’re basically running an insurance company, without any of the tools you need to run an insurance company.
When it comes to pharmacy, it’s even more complicated given the lightning-fast rate of change compared to the medical side of healthcare.
Well, along came the Transparency in Coverage Act to ratchet up the pressure even more on benefits leaders. In many ways, it has fundamentally reshaped the landscape for plan sponsors who, based on ERISA, have a fiduciary duty to act in the best interests of plan members. Part of this duty is the “duty of prudence”, and another key part is the “duty of care”. In order to support plans in their efforts to be good fiduciaries, this legislation, aimed at commercial plans, mandates clear and comprehensive disclosure of prescription drug pricing (Source: U.S. Department of Labor). The idea here is that you cannot possibly be living up to your duty of prudence or duty of care if you don’t have the information you would need to do so.
Recent legal challenges, including the Johnson & Johnson lawsuit (Source: Reuters), spotlight the critical importance of fiduciaries ensuring drug costs within their plans are justified and transparent. Such cases serve as stark reminders of the risks associated with opaque pricing practices…and that employees of the corporation (like benefits leaders) can be held personally liable for breach of their fiduciary duties.
As with most things in pharmacy, it’s never as easy as it should be to do what needs to be done. There are many important steps a plan sponsor can take to ensure they remain in compliance and, more importantly, deliver the best benefit possible to their plan members.
Here are tips from trial attorneys who are experts in our field:
However, “One easy step you can take is to make sure you have an independent, objective third party that monitors your plan and shows potential treatment options along with pricing, to your members,” says Jonathan E. Levitt, Esq. In cases like these, often “good faith” goes a long way. If a plan can demonstrate that it has taken actions like the ones discussed by Frier Levitt law firm, and use an independent Rx navigation solution like Scripta, it can be an excellent proof point that the prudence and care are being used by plan sponsors.
Navigating these regulatory waters requires effective tools like Scripta Insights' Rx Navigator, which provides actionable insights into drug pricing. By adopting such solutions, benefits professionals can mitigate legal risks and enhance cost management strategies in today's highly scrutinized environment.
So, embrace transparency. Equip yourself with the tools to navigate the complexities of drug pricing within benefit planning. Your diligence will not only protect your plan but also ensure you steer clear of potential regulatory storms that could otherwise rock your ship.
Commentaires