Judge Strikes Federal Rule Requiring Employers to Accommodate Employee Abortions
The Equal Employment Opportunity Commission (EEOC) went beyond a law crafted by Congress—the Pregnant Workers Fairness Act (PWFA)—when it
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Business Journals
2 hours ago
- Business Journals
Waiting for pharmacy benefit manager reform from Washington? Here's what to do now.
If you're frustrated with your pharmacy benefit manager (PBM), join the club. A recent survey found that three-fifths of large-company benefit leaders said their PBM contracts were opaque, overly complicated, and contained clauses that profit the PBM at the expense of employers and patients. Thankfully, you're not stuck. Washington is working on PBM reform, one of the rare issues for which there is agreement between both parties in Congress and the Trump administration. Of course, consensus isn't always enough to create legislation, and any passed law will take time to come into force. A recently-enacted bill in Colorado addresses some of these issues, but will not apply to many large employer-sponsored plans. What follows is a guide to the problems with PBM contracts, the reform proposals, and two approaches to addressing the existing issues that don't require waiting on Washington: Finding a new generation of PBM committed to more transparency; and Negotiating a more transparent arrangement with your current PBM. The problem with large PBMs Pharmacy benefit managers were created to reduce employer costs, yet over time they have evolved in ways that often incentivize increases in plan sponsor and employee costs: Vertical Integration: Nearly 80% of the prescription market (which totaled $600 billion in 2023) is controlled by PBMs run by the three largest health insurance carriers: CVS Caremark (owns Aetna), OptumRX (owned by UnitedHealth Group), and Express Scripts (owned by Cigna). Spread pricing: PBMs charge employers more than they pay pharmacies for drugs, keeping the difference. Drug company rebates: These payments are often in return for PBMs steering business to their products and can include other undisclosed fees. Misaligned Incentives: By favoring their own specialty and mail-order (or retail) pharmacies, PBMs may be restricting competition and limiting their interest in negotiating the lowest pharmacy markups. A recent FTC study found that PBMs often charged employers a markup for specialty drugs distributed through their affiliated pharmacies of more than 100% — and sometimes more than 1,000%. Recently, the big PBMs have started joint ventures to manufacture their own generic and biosimilar drugs, creating another potential conflict. Secrecy: PBM common practices such as spread pricing, rebates, contractual gag clauses, price list manipulation and others have created an environment ripe with opaqueness and confusion for employers. The proposed legislation Congress has been looking closely at PBM reform for several years, and a detailed bipartisan bill was removed from last December's stop-gap budget after Elon Musk tweeted that it was too long. Leading committees are now working to pass something similar. Indeed, two bills that passed Committee last year were reintroduced: The Prescription Pricing for the People Act directs the Federal Trade Commission to complete its ongoing study of PBM practices. The Pharmacy Benefit Manager (PBM) Transparency Act bans spread pricing, incentivizes PBMs to pass 100% of the rebates they receive to plan sponsors, encourages transparency, and requires annual reporting by PBMs of their pricing, reimbursement, and rebate practices. Other proposals go further, including the Patients Before Monopolies Act, which would ban PBMs and insurance companies from owning a pharmacy. The states have been busy as well, increasing their oversight of PBM practices through new legislation and reporting requirements. Unintended consequences of all of this are a concern for consultants and employers looking to control costs. In Colorado, Governor Polis signed HB 25-1094 into law in May. Effective in 2027, this law will regulate how PBMs can earn income, how they structure their formulary, and how they reimburse unaffiliated versus PBM-affiliated pharmacies, among other changes. Unfortunately, this new law won't apply to many large employer-sponsored healthcare programs. So large employers in Colorado are still left to design their own pharmacy strategy. Switching to a transparency-oriented PBM In recent years, more employers have switched their pharmacy programs to a new crop of PBMs who are unaffiliated with large insurers—including Navitus Health Solutions, Rightway Rx, Capital Rx, and SmithRx—and offer a more transparent business model. The advantages Pass-through pricing: Employers get the full benefit of network discounts and rebates, and instead of spread pricing, they pay a disclosed administrative fee per prescription. Fewer conflicts: The independent PBMs are less likely to have pharmacy operations or other business interests that differ from those of employers. Transparent disclosures: Employers get access to granular information about the pricing of each prescription rather than the opaque summaries provided by the large PBMs. Aggressive cost management: The independent PBMs emphasize lower net cost options in their formularies and have strict prior authorization requirements for more expensive drugs. The disadvantages Negotiating intermediaries: Since the upstart PBMs are small, many band together by using rebate aggregators, entities that negotiate lower prices with drug companies. But these negotiations have a downside: They can obscure the details of drug company rebates, especially since most of the aggregators are owned by the same insurance conglomerates that own the big PBMs. Potential disruption: Changing PBMs means employees must adjust to a new formulary, pharmacy network, and prior authorization procedures. Members may also object to the stricter utilization controls these companies use. Buying power: Smaller PBMs do not have the volume that the larger players do and are also unable to take on the risk of aggressive discount and rebate guarantees which can lead to a financial arrangement that appears to be less advantageous for employers. Renegotiating with your existing PBM Many companies that have investigated using a more transparent PBM ultimately decide that the advantages of sticking with a large provider outweigh the frustrations and potential conflicts. They are: Convenience: Dealing with one company that provides medical benefits, pharmacy benefits, and mail-order pharmacy service can be easier for employers and plan members alike. Lower effective prices: Some employers find that the greater bargaining clout of the large PBMs delivers good value even if the mechanics of their arrangements remain murky. Increased transparency efforts: Faced with the prospect of increased regulation, CVS Caremark, Express Scripts, and OptumRX have all announced programs that disclose more information about pricing and pass more of their rebates to employers. As they are just being instituted, their real-world impact remains to be seen. In any case, employers and their advisors can't afford to wait to scrutinize their PBM's business practices and press for more advantageous contracts. The time is now to: Look at the fine print: A typical PBM contract may specify high-level drug discounts, rebates, and dispensing fees. Dig deeper, and you can find exclusions and key definitions, such as what is a 'specialty drug.' Press for full pass-through of rebates: Work through every category and proposed exception to insist that rebates for all drugs go to the employer. Ask about conflicts: How does the PBM interact with its affiliated pharmacies? Are reimbursements different than those for independent pharmacies? Are the dispensed drugs made by brands it owns? Check its approach to cost control: What is its philosophy for adding drugs to its formulary? How does it generate prior authorization guidelines for drugs with high rebates? What percent of authorization requests are approved? Audit performance: At the end of a contract, demand a detailed itemization of all claims to ensure that the PBM has met its commitments. If it hasn't, fight for a financial adjustment. Whether your company decides to find a new PBM or renegotiate its deal with the current provider, there are a lot of details to consider. An experienced broker or consultant will help you sort through those complex contracts designed to confuse. And if Washington does end up passing PBM reform, that advisor will also be able to adapt your plan to take maximum advantage of the new rules. To learn more, contact Chris Mast, an actuary and benefits consultant with Alliant Employee Benefits in Greenwood Village, CO. Mast has worked with employers across Colorado and the US for more than 20 years. He can be reached at Alliant's Pharmacy team is made up of industry experts, pharmacists, and data specialists who provide marketplace perspective and insights, vendor capabilities, and practical knowledge to secure the best pricing and contract arrangements. Our buying power and partnerships enable us to support your benefits strategy, pharmacy program, and cost management throughout the entire program lifecycle. Learn more about Alliant at
Yahoo
2 hours ago
- Yahoo
Trump says he may want to give you a tariff rebate check: ‘A little rebate for people of a certain income level might be very nice'
President Trump has suggested that as part of his tariff policy, he would consider sending out rebate checks or tariff refund checks to Americans, funded by the revenue collected from the tariffs imposed on imported goods. 'We have so much money coming in, we're thinking about a little rebate for people of a certain income level,' Trump told reporters Friday outside the White House. 'A little rebate for people of a certain income level might be very nice.' The rebate would be drawn from the significant amount of tariff revenue collected by the U.S. government—over $100 billion in the first half of 2025 alone, according to Treasury data. Trump's remarks about these rebate checks perhaps being targeted to Americans 'of a certain income level' suggest they would likely be means-tested, but Trump offered few details about the exact income thresholds or amount of the rebate. The stated purposes of the rebate are to compensate Americans who may have faced higher prices as a result of the tariffs and to potentially provide a small economic stimulus, which gives new meaning to Trump's remarks about businesses 'eating the tariffs,' with much economic debate over who is really footing the bill for them. Any such rebate policy would likely require congressional approval, and lawmakers like Sen. Josh Hawley have indicated support for legislation that would deliver rebate checks to working Americans, but no bill text or timetable has been specified. If enacted, the administration would need to establish eligibility rules, application or automatic distribution methods, and payment logistics. This could resemble past stimulus check programs, but that is just theoretical at this point. The rebate concept is distinct from legal or administrative tariff refunds to importers, which have been considered or mandated following court rulings questioning the legality of some tariffs. In such cases, refunds would go to the companies that paid the import duties, not directly to end consumers. Is this legal? Trump's proposed tariff refund checks—rebates funded by tariff revenue and distributed directly to American consumers—would almost certainly require explicit legislation from Congress to be legally valid, given that the U.S. Constitution gives Congress—not the president—the power to levy tariffs and appropriate federal funds. The president can impose certain tariffs under delegated statutory authorities, but courts have repeatedly found that the sweeping use of these powers under the International Emergency Economic Powers Act (IEEPA) is not legal. Multiple recent court rulings (including a unanimous U.S. Court of International Trade decision) have blocked Trump's broad tariffs for lacking legal basis under the IEEPA, yet the tariffs remain in place pending appeal and, theoretically, a Supreme Court ruling. Trump's busy July The suggestion of tariff rebate checks or refund checks is another new policy suggestion from Trump in a July that has been full of them, as Washington, D.C., has been roiled by a metastasizing scandal involving disgraced deceased pedophile Jeffrey Epstein. Trump's Justice Department is facing bipartisan criticism for its decision not to release the so-called Epstein files, which the Justice Department has said do not exist. The Wall Street Journal has published a series of scoops about Trump's past closeness to Epstein, including Trump's name being mentioned in the files. In July, Trump said he had reached an agreement with Coca-Cola to bring real sugar back into the Coke formula, which the company partially confirmed days later. He also demanded the Washington Commanders football team revert to their former 'Redskins' name, threatening political obstruction for their stadium project if they did not comply. He announced the release of 230,000 files related to Martin Luther King Jr. And he escalated his feud with the Federal Reserve and Chair Jerome Powell, visiting the in-process office renovations in a hard hat and engaging in a bizarre, comedic argument with Powell about cost overruns on live television. For this story, Fortune used generative AI to help with an initial draft. An editor verified the accuracy of the information before publishing. This story was originally featured on
Chicago Tribune
2 hours ago
- Chicago Tribune
Visclosky leaves airport authority; Braun to name new chairman
Former U.S. Rep. Peter J. Visclosky has stepped down as chairman of the Gary/Chicago International Airport Authority, officials said during Friday's meeting in Gary. Visclosky did not attend the meeting. Former Republican Gov. Eric Holcomb appointed Visclosky authority chairman in 2022. A Gary Democrat, Visclosky left Congress in 2020 after 35 years in the U.S. House of Representatives, from Indiana's 1st District. By state law, the governor appoints the chairman of the authority. Visclosky's term doesn't expire until Jan. 31, 2026. His replacement hasn't been announced yet by Gov. Mike Braun. Tom Collins Jr., Porter County's representative on the authority, announced Visclosky's retirement at the end of the meeting. 'He came in with a mission,' Collins said of Visclosky. He said Visclosky helped negotiate a separation agreement with Avports/AFCO LLC, a private company that ran airport operations for eight years. Under Visclosky, the airport once again ran operations in-house under the leadership of executive director Dan Vicari, who was hired in January 2022. Collins credited Visclosky with upgrading the airport's accounting systems and correcting past audit issues. He said Visclosky also 'championed' the airport compact agreement with the city of Chicago and helped collect funding from Chicago. Collins said Visclosky continued to work with his successor, U.S. Rep. Frank J. Mrvan, D-Highland, toward airport improvements including a new hangar and a new $15 million cargo ramp. Authority member Millicent Lyles said she's never witnessed leadership as strong as Visclosky's. 'He didn't do that by being the biggest voice or the biggest ego. He did that by encouraging people to speak up and voice their own opinion,' she said. As the authority's lone woman member, Lyles said Visclosky helped build her confidence 'and that is something I will hold dearly,' she said. Authority member Trent McCain, who served as deputy mayor when Visclosky joined the board, said Visclosky often called the authority the first board he ever worked on. 'From day one, he was dedicated to learning the business and dedicated to moving the airport forward.' In other business, the board awarded a $15 million contract to Superior Construction, of Gary, to build a new cargo and general aviation concrete ramp on 8.5 acres on the airport's west end. Vicari called it the airport's biggest investment since its $174.1 million runway extension project in 2015. UPS, which leases space at the airport, will use the new ramp to expand its operations. It's now based at the airport's passenger terminal. Airport officials hope to attract more cargo business, in addition to UPS. Officials said work would begin in September and take about 120 days. Vicari said funding came from Mrvan's community projects fund and from former President Joe Biden's bipartisan infrastructure law. The airport's cost share is $300,000. The authority also approved a $258,354 contract with Frequentis USA Inc. for a new voice switch communications system for the airport's tower. Airport operations director Ken Cast said the old communications console dates back to 1988 and parts and support were no longer available. The authority approved a settlement agreement with the fixed-based operator Gary Jet Center related to the payment of landing fees in its lease. The settlement amount wasn't disclosed.
