A 5-point checklist for CAA compliance on Rx fiduciary oversight

Below is an excerpt from an article by AlignRx COO Greg Sanderson that was recently published by Employee Benefit News.

As healthcare costs continue to rise, a notable shift is occurring: employees are challenging these increases with unprecedented vigor. Armed with a growing awareness of their rights and the potential for more equitable healthcare solutions, workers are pushing back against what they see as irresponsible benefit practices. This movement is gaining momentum in the wake of significant legal actions, including the recent class action lawsuit against Johnson & Johnson over pharmacy costs, spotlighting the crucial role of fiduciary duty in managing pharmacy benefits. The Consolidated Appropriations Act (CAA) further emphasizes this focus, setting strict compliance benchmarks and underscoring the importance of cost-effective, transparent healthcare benefits.

This evolving dynamic places employers in a critical position. They are now tasked with navigating the complex interplay between meeting regulatory standards, managing costs and addressing their employees’ demands for fair and transparent healthcare pricing. The challenge is significant, yet it offers an opportunity to foster a more transparent, equitable healthcare system that benefits all stakeholders. It’s important to note that the journey towards CAA compliance extends beyond the measures listed here. However, this strategic checklist provides a solid foundation for employers eager to align their practices with the principles of responsibility and prudence in their healthcare benefits management efforts.

1. Conduct Annual Market Checks

It’s essential to reassess your PBM contracts annually to ensure you’re receiving the most competitive rates. Market dynamics fluctuate, and what was a competitive rate a year ago might not be the best deal today. This proactive approach prevents contracts from becoming stale and ensures that your pharmacy benefits offerings remain financially sustainable and beneficial to your members.

View the rest of the list on Employee Benefit News.