Exposing the Hidden Costs: A Four-Part Series on Pharmacy Benefit Fraud, Waste, and Abuse If you’re a plan sponsor still looking at fraud, waste, and abuse (FWA) through the lens of member misuse or doctor shopping, you’re only seeing the surface. The most damaging form of FWA, in pharmacy benefits today isn’t being driven by patients, prescribers, or even pharmacies. It’s baked into your non-fiduciary PBM contract. When the gatekeeper is the problem, the entire system breaks When Misaligned Incentives Become a Business Model Most employers assume their PBM partner is working on their behalf. After all, they’re the ones “managing” your plan. But when your PBM profits more when you spend more, that’s not plan management. It’s margin extraction. This is FWA at the structural level. Five Ways Non-Fiduciary PBMs Exploit the System (and Your Budget) 1. Spread Pricing The PBM bills your plan $120 for a generic drug and pays the pharmacy $6. That $114 spread? It stays with the PBM. Multiply that across millions of claims and you start to understand why this is a preferred revenue stream. Unless your contract explicitly bans it, it’s happening. 2. Rebate Chasing Non-fiduciary PBMs often favor high-rebate drugs even when lower-cost alternatives are clinically equal or superior. Why? Because they retain a portion of the rebate, often undisclosed, and build formularies to maximize rebate revenue, not member outcomes or net cost efficiency. 3. Specialty and Mail-Order Steering PBMs own pharmacies and they profit by steering members toward their own dispensing channels, often for drugs with low clinical value. These internal referrals frequently bypass lower-cost, clinically appropriate alternatives, increasing plan costs and leaving members to pay more out of pocket for medications that offer little added benefit. 4. Vague Contract Terms “Pass-through pricing,” “rebates,” and “guarantees” sound good until you realize none of those terms are precisely defined. Loopholes allow PBMs to reclassify revenue, exclude certain drugs, or apply creative accounting to reduce what gets passed through. 5. Data Obstruction If you don’t have full visibility into claims-level data, including the amount paid to the dispensing pharmacy, you’re operating blind. And that’s exactly how your non-fiduciary PBM wants it. FWA by Design, Not Mistake This isn’t accidental. It’s not a bad actor. It’s a system that’s been carefully engineered to enrich PBMs under the radar of plan sponsors. Many employers don’t even realize they’re being taken for a ride until an audit uncovers millions in avoidable spend. And even then, most plans settle for minor corrections instead of a total structural reset. How to Fight Back Demand a fiduciary-standard contract: Clear terms. No spread. 100% rebate pass-through. Auditable.Control the formulary: Don't allow a non-fiduciary PBM choose your drug list without scrutiny.Build in oversight: Require monthly reporting and quarterly audits, not just vague performance guarantees.Benchmark everything: Ingredient costs, dispensing fees, and rebates down to the claim level. Bottom Line PBM-driven FWA isn’t a footnote. It’s the headline. If you don’t fix this first, you’re just rearranging deck chairs on the Titanic. Coming…

SCOTUS declines to hear PBM case and other news from around the interweb: Get Certified Now! SCOTUS declines to hear PBM case. The Supreme Court declined Monday to consider an appellate court’s 2023 decision overturning portions of an Oklahoma law regulating pharmacy benefit managers, raising questions about the implications for state actions to rein in the companies’ business practices. The 10th Circuit appeals court ruled that federal laws regulating private employer-sponsored health plans and Medicare’s drug benefit preempt the 2019 state law’s provisions that aimed to bolster independent pharmacies’ bargaining power with PBMs, which help negotiate retail drug prices between drugmakers and payers. Community pharmacies have long panned the middlemen — which are responsible for 80 percent of the market — for steering customers toward pharmacy chains they own. CMS head urges PBMs to end drug rebates. CMS chief Mehmet Oz, MD, is calling on the nation’s largest pharmacy benefit managers to voluntarily abandon the current drug rebate model, or risk its elimination by the government, Bloomberg reported June 24. “There’s a possibility that we have a window now where three big PBMs might actually consider doing away with the rebate/kickback system,” Dr. Oz said. The remarks signal that the Trump administration may revive attempts to eliminate the payments drugmakers send to pharmacy benefit managers after prescriptions are filled. FTC Issues Warning on Rebates That Block Lower-Cost Drugs. The Federal Trade Commission (FTC) has issued a policy statement outlining its approach to regulating pharmaceutical rebates and fees under Section 5 of the FTC Act. The statement, released on June 8, 2025, focuses on practices that allegedly harm competition in the prescription drug market. Specifically, the FTC highlights concern over rebate agreements and fee structures between pharmaceutical manufacturers and pharmacy benefit managers (PBMs), which it claims may unfairly exclude competitors or restrict access to lower-cost drugs. How to Create an AI Foundation for Your Benefits Strategy. Employers want to use artificial intelligence-driven analytics to drive up benefits engagement but need the right foundation in place to generate these insights. One in two employers believe that acting on analytical insights will lead to improved employee performance and engagement. It’s therefore unsurprising that employers across the globe are now planning to use AI (artificial intelligence) to generate these insights. More than eight out of 10 (85%) HR professionals plan to use AI in relation to their employee benefits over the next year. The overall goal is to understand their people and tailor employee benefits, communications, and experiences to drive up benefits engagement. Why TransparentRx Is Your Trusted Partner for Smarter Pharmacy Benefits At TransparentRx, we specialize in delivering fiduciary pharmacy benefit management services that prioritize transparency, cost containment, and optimal patient outcomes. Our unique approach helps self-funded employers, benefits consultants, and health plan sponsors navigate the complexities of pharmacy benefits while reducing costs and enhancing care. If you're ready to take control of your pharmacy benefit strategy and eliminate hidden fees, contact TransparentRx today for a consultation. Let us help you achieve smarter,…

CMS head urges PBMs to end drug rebates and other news from around the interweb: Get Certified Now! CMS head urges PBMs to end drug rebates. CMS chief Mehmet Oz, MD, is calling on the nation’s largest pharmacy benefit managers to voluntarily abandon the current drug rebate model, or risk its elimination by the government, Bloomberg reported June 24. “There’s a possibility that we have a window now where three big PBMs might actually consider doing away with the rebate/kickback system,” Dr. Oz said. The remarks signal that the Trump administration may revive attempts to eliminate the payments drugmakers send to pharmacy benefit managers after prescriptions are filled. FTC Issues Warning on Rebates That Block Lower-Cost Drugs. The Federal Trade Commission (FTC) has issued a policy statement outlining its approach to regulating pharmaceutical rebates and fees under Section 5 of the FTC Act. The statement, released on June 8, 2025, focuses on practices that allegedly harm competition in the prescription drug market. Specifically, the FTC highlights concern over rebate agreements and fee structures between pharmaceutical manufacturers and pharmacy benefit managers (PBMs), which it claims may unfairly exclude competitors or restrict access to lower-cost drugs. How to Create an AI Foundation for Your Benefits Strategy. Employers want to use artificial intelligence-driven analytics to drive up benefits engagement but need the right foundation in place to generate these insights. One in two employers believe that acting on analytical insights will lead to improved employee performance and engagement. It’s therefore unsurprising that employers across the globe are now planning to use AI (artificial intelligence) to generate these insights. More than eight out of 10 (85%) HR professionals plan to use AI in relation to their employee benefits over the next year. The overall goal is to understand their people and tailor employee benefits, communications, and experiences to drive up benefits engagement. COA Files Amicus Brief Supporting 340B Rebate Model Appeal, Warning of PBM Takeover and Urging Congressional Action. The brief, filed in the U.S. Court of Appeals for the D.C. Circuit in support of Novartis and Bristol Myers Squibb in the case Novartis Pharmaceuticals Corporation v. U.S. Department of Health & Human Services et al., docket number 24-2968, reinforces COA’s call to restore the 340B program to its original purpose – helping patients in need – by exposing and reversing the growing financial exploitation of the program by pharmacy benefit managers (PBMs) and hospital systems. Why TransparentRx Is Your Trusted Partner for Smarter Pharmacy Benefits At TransparentRx, we specialize in delivering fiduciary pharmacy benefit management services that prioritize transparency, cost containment, and optimal patient outcomes. Our unique approach helps self-funded employers, benefits consultants, and health plan sponsors navigate the complexities of pharmacy benefits while reducing costs and enhancing care. If you're ready to take control of your pharmacy benefit strategy and eliminate hidden fees, contact TransparentRx today for a consultation. Let us help you achieve smarter, more effective benefits management.

That $99 Spirit Airlines fare grabs your attention. But once you add a carry-on, pick a seat, print a boarding pass, and pay all the extras, you often spend more than you would for the all-in fare at United, for instance. You are packed in with no legroom, nickel-and-dimed the entire way, and left stranded if you need support. Now picture that same approach in pharmacy benefits management. What budget airlines can teach us about PBMs is that low upfront costs don’t guarantee value unless transparency and accountability are built into the model. Non-fiduciary PBMs hook employers with what looks like a low admin fee, such as $4.50 or $6.95 PMPM. Just like with the airlines, the real cost is buried in the fine print: spread pricing, retained rebates, restricted audit rights, and poor clinical oversight. What seemed like a deal ends up costing far more once everything is tallied. Spirit adds more seats to shrink legroom and boost margins. Similarly, non-fiduciary PBMs pad their formularies with high-rebate drugs to increase their revenue, not because these medications work better or cost less for patients. The result is poor patient outcomes and higher total costs. When you ask for transparency or try to audit where the dollars go, you hit a wall. Plan sponsors pay the PBM twice: once for the actual cost of the drugs and again as a separate fee to manage the pharmacy benefit. At TransparentRx, our management fee (∽ $14.95 PMPM) is the full fare. It covers everything, including prior authorizations, appeals, utilization management, and cost-containment programs that other PBMs often carve out and mark up. These services are not optional; they impact access, adherence, and total cost of care. We do not upcharge for them or hide them in separate agreements. There are no hidden revenue streams or backdoor profits. Our formularies are built around clinical value and the lowest net cost, not the size of a rebate check. Every dollar saved goes back to the plan sponsor. We put that in writing, under a fiduciary standard. Low-cost marketing does not mean low total cost. Whether it is flying or pharmacy benefits, if the price looks too good to be true, check the cargo hold. There is almost always something hiding in there. Elevate your expertise in pharmacy benefits management with the Certified Pharmacy Benefits Specialist® (CPBS) program, sponsored by the UNC-Chapel Hill Eshelman School of Pharmacy. Whether you're an HR leader, finance executive, consultant, or pharmacist, this certification provides the in-depth knowledge and strategic insight needed to manage pharmacy benefits with confidence and cost efficiency. Gain up to twenty continuing education credits, enhance your career prospects, and help your organization take control of pharmacy spend. Register today to join a growing network of professionals shaping the future of pharmacy benefits management. Learn more at the Pharmacy Benefit Institute of America.

Selecting a pharmacy benefit manager isn't about choosing the vendor with the most rebates or slickest presentation. It's about making a defensible, fiduciary-grade decision based on transparency, alignment, and timing discipline. Below is the perfect timetable for PBM RFPs, with practical checkpoints to avoid costly mistakes. At a Glance: PBM RFP Timeline January to March: Design the Process with Purpose The first quarter is where leverage is built. Draft the RFP with clear, measurable requirements tied to financial and operational accountability.Select invitees based on performance and transparency. Decide whether to include the incumbent.Require full disclosure from consultants and vendors on all PBM relationships and revenue streams. This is a baseline requirement for fiduciary oversight.Clarify objectives early. The end goal is auditability and alignment with the plan's financial interests, not just the appearance of savings. Rushing this setup invites downstream failure. Plans that skip or delay this step often end up renegotiating under pressure or settling for status quo. April to May: Distribute with Discipline This stage is about enforcement. Release the RFP and allow a minimum of three weeks for responses.Avoid Excel-based distribution. Use a secure RFP platform to reduce version confusion, data loss, and exposure risks.Require structured responses that bind the PBM to disclosed pricing, service guarantees, and contractual terms. Firms that resist or withhold key information are self-selecting out. Let them. June to July: Evaluate and Extract Now the focus shifts to assessment and leverage. Score only what can be verified. Eliminate vendors who offer soft promises with no contractual commitment.Prioritize fiduciary alignment. Vendors that operate on radical transparency, pass-through pricing, and contract clarity should move forward.Conduct interviews with purpose. These are not meet-and-greets. They are working sessions to confirm commitments and gain pricing or service concessions.Select semi-finalists. Selections are based on binding contract terms and pricing not vague claims or verbal assurances. If it's not in writing, it doesn't count. This is where most plans get swayed by presentations or legacy comfort. Don't lose leverage. Keep the process objective. August: Finalize and Sign This is the decision point. Select the winning PBM based on documented commitments, not who talked the best game.Execute the agreement immediately. All terms should already be finalized through prior documentation rounds. If your advisor is still negotiating at this point, the process was mishandled. A PBM should never be chosen before their contract terms are locked in writing. September to December: Transition with Precision This phase ensures readiness by go-live. Refine plan design. Adjust formularies, prior authorization rules, and benefit carve-ins or carve-outs.Test system integration. Ensure eligibility feeds, accumulator syncing, and claims adjudication are working as intended.Prepare member communication. This includes ID cards, digital tools, benefit summaries, and support resources.Launch open enrollment with full confidence in operational execution. Waiting until the fourth quarter to begin implementation planning puts the entire program at risk. The Takeaway A PBM RFP is not a paperwork exercise. It is a financial event with significant implications for cost control, member outcomes, and fiduciary liability. The perfect timetable is…

FTC Issues Warning on Rebates That Block Lower-Cost Drugs and other news from around the interweb: Get Certified Now! FTC Issues Warning on Rebates That Block Lower-Cost Drugs. The Federal Trade Commission (FTC) has issued a policy statement outlining its approach to regulating pharmaceutical rebates and fees under Section 5 of the FTC Act. The statement, released on June 8, 2025, focuses on practices that allegedly harm competition in the prescription drug market. Specifically, the FTC highlights concern over rebate agreements and fee structures between pharmaceutical manufacturers and pharmacy benefit managers (PBMs), which it claims may unfairly exclude competitors or restrict access to lower-cost drugs. Recalibrating employee benefits: How companies are delivering value in a cost-constrained world. As employers head further into 2025, one message is clear: the old rules of employee benefits are fundamentally changing. With rising costs, economic instability, and employees demanding more support and personalization, organizations must transform how they think about benefits. Yet, this isn't a story of increased budgets and ever-increasing programs. Instead, it's a story of smarter spending, sharper focus and using benefits as a strategic tool to drive engagement, retention, and purpose. How to Create an AI Foundation for Your Benefits Strategy. Employers want to use artificial intelligence-driven analytics to drive up benefits engagement but need the right foundation in place to generate these insights. One in two employers believe that acting on analytical insights will lead to improved employee performance and engagement. It’s therefore unsurprising that employers across the globe are now planning to use AI (artificial intelligence) to generate these insights. More than eight out of 10 (85%) HR professionals plan to use AI in relation to their employee benefits over the next year. The overall goal is to understand their people and tailor employee benefits, communications, and experiences to drive up benefits engagement. 83% of Americans Unwilling to Pay More Than $100 for GLP-1s, Survey Shows. While Americans understand the benefits of GLP-1 agonist medications, 83% of Americans are unwilling to pay more than $100 in monthly health insurance premiums for them, even if they were covered, according to the results of the recent KPMG American Perspectives Survey. Willingness to pay differed across age groups. Gen Z was the most likely to pay at 27%, followed by 21% of Millennials, 14% of Gen X and just 6% of Baby Boomers, indicating a generational divide. Why TransparentRx Is Your Trusted Partner for Smarter Pharmacy Benefits At TransparentRx, we specialize in delivering fiduciary pharmacy benefit management services that prioritize transparency, cost containment, and optimal patient outcomes. Our unique approach helps self-funded employers, benefits consultants, and health plan sponsors navigate the complexities of pharmacy benefits while reducing costs and enhancing care. If you're ready to take control of your pharmacy benefit strategy and eliminate hidden fees, contact TransparentRx today for a consultation. Let us help you achieve smarter, more effective benefits management.

Most HR departments don’t have a pharmacy benefit team. They rely on brokers or health plan reps to manage the PBM, rarely dig into pharmacy-specific metrics, and assume someone else is watching the details. But pharmacy benefits are where the real complexity and often the greatest waste lives. If you’re in HR and pharmacy benefits are buried in your broader health plan workflow, this is your opportunity. A small, focused team or even just the right external partners can unlock savings, improve member outcomes, and give your plan the transparency it deserves. Here’s how smart HR leaders are making it happen. Start With a Fiduciary Mindset Pharmacy benefits shouldn’t be managed as just another health plan line item. Most PBMs operate on a profit model that rewards opacity and misalignment. The only way around that is to establish fiduciary-level oversight, acting solely in the best interest of your plan and its members. Even if you don’t have internal pharmacy experts, you can adopt a fiduciary mindset by bringing in partners who work exclusively for you. That means no commissions, no hidden fees, and no loyalty to anyone but your plan. The Roles That Matter Most You don’t need a new department. But you do need someone thinking about pharmacy every day. That might mean reallocating responsibilities within HR or outsourcing to fiduciary-aligned consultants. These are the core roles worth investing in: Pharmacy Benefit Strategist Brings experience from inside the PBM world. Knows what to ask, what to audit, and how to negotiate terms that actually protect your plan.Contract and Procurement Lead Reviews PBM contracts with a fine-tooth comb. Looks for soft guarantees, ambiguous language, and misaligned incentives.Data Analyst or Actuarial Support Translates raw claims into clear insights. Helps model new benefit designs, forecast impact, and identify cost drivers.Clinical Oversight (Pharmacist or Consultant) Ensures utilization management is rooted in evidence, not just cost-shifting. Essential for specialty, GLP-1s, and PA protocols.Project Manager or Implementation Lead Keeps audits, vendor changes, and benefit updates on track. Without this role, good strategy gets stuck in limbo. Strengthen Your Oversight to Get More from Your PBM Relationship Your PBM plays a critical role in managing drug costs, access, and outcomes. Like any complex vendor relationship, the more engaged and informed your team is, the better results you will see. A dedicated pharmacy benefit team allows HR to become an active participant in decision-making rather than just a recipient of updates. This improves the PBM partnership by bringing more clarity, better communication, and shared accountability. When your team is prepared to review data, manage contracts, and provide clinical insight, it creates the structure for a stronger partnership. Your PBM can focus on delivering value, while your team ensures that value aligns with your plan’s goals. It's not about stepping on toes. It's about stepping up. Build Audit and Oversight Into Your Routine Oversight isn’t just an annual rebate check. A good pharmacy benefit team will regularly review: Rebate guarantees and actual pass-throughFormulary changes and exclusionsPrior authorization outcomesSpecialty…

83% of Americans Unwilling to Pay More Than $100 for GLP-1s, Survey Shows and other news from around the interweb: Get Certified Now! 83% of Americans Unwilling to Pay More Than $100 for GLP-1s, Survey Shows. While Americans understand the benefits of GLP-1 agonist medications, 83% of Americans are unwilling to pay more than $100 in monthly health insurance premiums for them, even if they were covered, according to the results of the recent KPMG American Perspectives Survey. Willingness to pay differed across age groups. Gen Z was the most likely to pay at 27%, followed by 21% of Millennials, 14% of Gen X and just 6% of Baby Boomers, indicating a generational divide. Patients Taking Newer Weight Loss Drugs Likely to Return to Their Original Weight Within 2 Years, Study Says. A new analysis discovered that patients who stop using weight loss drugs like Wegovy and Mounjaro are likely to regain the total weight they had lost in less than two years. The review, conducted by the University of Oxford's Biomedical Research Centre, sought to measure weight gain after stopping the use of weight loss medication, or GLP-1 receptor agonists. Researchers determined that ceasing older weight loss medications resulted in a return to original weight within one year — and less than two years for newer weight loss medications. Recalibrating employee benefits: How companies are delivering value in a cost-constrained world. As employers head further into 2025, one message is clear: the old rules of employee benefits are fundamentally changing. With rising costs, economic instability, and employees demanding more support and personalization, organizations must transform how they think about benefits. Yet, this isn't a story of increased budgets and ever-increasing programs. Instead, it's a story of smarter spending, sharper focus and using benefits as a strategic tool to drive engagement, retention, and purpose. How to Create an AI Foundation for Your Benefits Strategy. Employers want to use artificial intelligence-driven analytics to drive up benefits engagement but need the right foundation in place to generate these insights. One in two employers believe that acting on analytical insights will lead to improved employee performance and engagement. It’s therefore unsurprising that employers across the globe are now planning to use AI (artificial intelligence) to generate these insights. More than eight out of 10 (85%) HR professionals plan to use AI in relation to their employee benefits over the next year. The overall goal is to understand their people and tailor employee benefits, communications, and experiences to drive up benefits engagement. Why TransparentRx Is Your Trusted Partner for Smarter Pharmacy Benefits At TransparentRx, we specialize in delivering fiduciary pharmacy benefit management services that prioritize transparency, cost containment, and optimal patient outcomes. Our unique approach helps self-funded employers, benefits consultants, and health plan sponsors navigate the complexities of pharmacy benefits while reducing costs and enhancing care. If you're ready to take control of your pharmacy benefit strategy and eliminate hidden fees, contact TransparentRx today for a consultation. Let us help you achieve smarter, more…

If your PBM offers point solutions, it may tout a dozen digital tools and apps, such as drug price checkers, copay maximizers, and adherence programs, but if employees aren’t using them, they’re just noise. And here’s the uncomfortable truth: most point solutions fail quietly. HR rarely hears about it until the plan year ends and the cost savings they were promised didn’t show up. So why aren’t employees engaging with these tools? It usually boils down to three things: they’re disconnected, poorly promoted, or frustrating to use. And that’s a PBM problem, not an HR one. Click to Learn More A relevant excerpt from Nudge: Improving Decisions About Health, Wealth, and Happiness by Richard H. Thaler and Cass R. Sunstein is: “A nudge, as we will use the term, is any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options or significantly changing their economic incentives.” Integration is everything Point solutions shouldn’t feel like third-party bolt-ons. If your PBM is serious about outcomes, they’ll embed these tools directly into your existing member portal with single sign-on and real-time data syncing. If your team has to remind employees to “also check this other tool” for savings, it has already failed. Engagement requires more than an email blast Employees are overwhelmed with benefits information. If a point solution is going to make a difference, communication must be timely and personalized. For example, Mark Cuban's Cost Plus Drugs, Built In: When we integrated Mark Cuban Cost Plus Drug Company pricing into our member portal, we didn’t just offer a link. We embedded the pricing engine directly into the member experience. Here’s what that looked like: Members search for a drug in the portal and instantly see Cost Plus pricing side by side with their plan benefit price.If Cost Plus is cheaper, we don’t just show it, we guide the member through the purchase process, including physician coordination when needed.No new account. No extra login. Just real-time data, simple instructions, and fast results. That’s what drives engagement: relevance, timing, and ease. Design like it’s 2025 If the interface looks like it was built during the Blackberry era, no one’s touching it. These tools must be mobile-first, intuitive, and backed by live support when needed. No friction. No confusion. Just a clear benefit and a straightforward way to use it. What HR can do Ask your PBM for usage data. If fewer than 30% of eligible members are engaging, that’s a red flag.Push for integration. Demand tools that are built into the member portal—not just added on.Tie point solutions to plan design. If a lower-cost option exists but isn’t surfaced automatically, the PBM isn’t doing its job. Your goal isn’t to offer more tools. It’s to offer fewer tools that work. If engagement isn’t baked in, then savings and outcomes are just marketing copy. And that’s not good enough, not for your employees, and not for your health plan.

Private Equity Firms Gobbling Up Health Care Facilities at a Skyrocketing Pace and other news from around the interweb: Get Certified Now! Private Equity Firms Gobbling Up Health Care Facilities at a Skyrocketing Pace. In 2024 Steward Health Care filed for bankruptcy, depriving socioeconomically disadvantaged communities of essential health services, straining nearby state hospitals, and leaving more than 4,430 health providers, staff, and administrators out of a job. Steward, formerly the Caritas Christi Health Care System, was once the second-largest health care system in New England, employing over 12,000 people and serving more than one million patients each year—from poor and working-class communities. A nonprofit system of six Catholic hospitals in cities like Brockton, Dorchester and Fall River, Caritas was acquired in 2010 by the private equity firm Cerberus Capital Management. Cerberus, which takes its name from the mythical three-headed dog that guards the gates of the underworld, converted Caritas into a for-profit system and rebranded it as Steward Health Care. Patients Taking Newer Weight Loss Drugs Likely to Return to Their Original Weight Within 2 Years, Study Says. A new analysis discovered that patients who stop using weight loss drugs like Wegovy and Mounjaro are likely to regain the total weight they had lost in less than two years. The review, conducted by the University of Oxford's Biomedical Research Centre, sought to measure weight gain after stopping the use of weight loss medication, or GLP-1 receptor agonists. Researchers determined that ceasing older weight loss medications resulted in a return to original weight within one year — and less than two years for newer weight loss medications. Stuck in the Middle: Self-Funded Health Plans and Recent Challenges to State PBM Laws. In recent years, prescription drug prices have been top-of-mind for state legislators, who have responded by passing laws that seek to control that pricing in a variety of ways, including by regulating pharmacy benefit managers (PBMs). While states are permitted to regulate fully insured products offered in their state, including mandating the benefits that insurers must offer, the Employee Retirement Income Security Act of 1974, as amended (ERISA) preempts state laws that impermissibly relate to self-funded employer-sponsored health plans that are subject to ERISA. New law raises prescription drug costs for most Hoosiers. Because most Hoosiers rely on their employers for health care coverage and the manufacturing industry employs 1 in 5 Hoosiers, the Indiana Manufacturers Association (IMA) has long championed efforts to control spiraling health care costs. This issue is critical to individuals and employers alike, and the IMA is encouraged that Indiana has seen a lot of improvement on this topic in recent legislative sessions. Senate Enrolled Act 140, however, takes a step in the wrong direction. By mandating pharmacy dispensing fees, SEA 140 will ultimately burden employers and individuals with higher prescription drug expenses across the board. At the heart of our concern is the provision within SEA 140 that mandates insurers, pharmacy benefit managers, or other administrators of pharmacy benefits to reimburse pharmacies at a…