Despite transparency regulations and the CAA, employers have gained little traction in their contracting with carriers, TPAs and PBMs. Most of today’s intermediary tactics still enable them to significantly increase revenue without providing equivalent value to employers or their covered populations. We need to hit the reset button and focus on transparent contracting in both the medical and pharmacy benefit, which includes: gag clauses, claims payments, medical Rx rebates, 340B, overpayments/reconciliations/recoveries, what’s considered “proprietary, confidential and reasonable” and more.
