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The New PBM Transparency Rules: What Plan Sponsors Are Actually Asking For

  • 69 minutes
  • 36 slides
What we'll cover
  • 0:00 Why Sponsors Are Pressing Now
  • 8:00 Rule Changes That Matter Most
  • 18:00 The Sponsor Question Shift
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What you'll take away

Practical shifts you can apply this week

  • Identify Priority Disclosure Categories

    Spot which disclosures sponsors now expect first, so reviews start with the right evidence.

  • Compare Rules To Operations

    See where legal requirements stop short of the details needed to manage PBM performance.

  • Evaluate PBM Reports For Gaps

    Review pricing, rebate, formulary, and specialty data with a sharper eye for omissions.

  • Draft A Practical Question Set

    Leave with prompts you can use in renewals, audits, and quarterly business reviews.

  • Decide When Findings Trigger Action

    Know which issues call for contract changes, escalation, or a closer vendor review.

Agenda

What we'll cover

  1. 0:00

    Why Sponsors Are Pressing Now

    What changed from 2024 to 2026, and why partial disclosure no longer satisfies boards or fiduciaries.

  2. 8:00

    Rule Changes That Matter Most

    Federal and state developments, ERISA relevance, and where required disclosure still falls short.

  3. 18:00

    The Sponsor Question Shift

    How sponsor questions moved from broad transparency requests to net cost, fees, decision rights, and specialty.

  4. 27:00

    Reading The PBM Data Trail

    How to connect claims, rebates, fees, and pharmacy payments into one auditable story.

  5. 37:00

    Contract Terms Under Pressure

    Which pricing definitions, audit rights, and remedy clauses matter once transparency findings show up.

  6. 48:00

    High-Stakes Areas Sponsors Probe

    A look at specialty, formulary tradeoffs, accumulators, maximizers, and affiliate steering concerns.

  7. 55:00

    Practical Playbook And Q&A

    Recap the framework, outline a 30-day action plan, and answer attendee questions.

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