Executive Brief Michael and Susan Dell just pledged $6.25 billion to fund investment accounts for 25 million American children. Each child receives about $250, a seed that will grow over decades. It is arguably the largest single gift Americans have ever received from two of their fellow citizens. Their generosity deserves celebration. It's a historic investment in America's future. Here's what every employer in the country should understand: you can do the same thing for the children of your...
9 days ago • 4 min read
Executive Brief October 5 was a good day for transparency. Interagency coordination is real and visible. Four federal agencies announced coordinated rules tightening health plan disclosure requirements. The FTC sent warning letters to 24 hospital systems. DOL's Dan Aronowitz reminded plan sponsors that "to whom much is given, much will be expected." October 5 was about transparency. It complements another accountability mechanism that has been building in the courts since March. In Stern v....
16 days ago • 7 min read
Executive Brief Most plan sponsors believe they've satisfied CAA compensation disclosure requirements. They received a document from their benefits advisor. They filed it. They're missing fourteen other vendor categories. CAA 2026 rewrote one phrase in ERISA section 408(b)(2). Where the law said "brokerage services," it now says "services, including brokerage services." The list of enumerated services now names the vendor categories: your PBM, your TPA, your stop-loss carrier, your EAP, your...
23 days ago • 6 min read
Executive Brief Here's a question benefits advisors are not asking often enough: If your client gets sued over their PBM contract, what will discovery reveal about your role? The Schlichter playbook for plaintiffs is now established. The lawsuits name the employer. Discovery follows the paper trail backward: who was in the room during selection, who recommended the terms, who blessed the renewal. That trail leads to you as the advisor. This is the discoverability problem. Not whether you did...
30 days ago • 6 min read
Plans Negotiate the Price. PBMs Write the Rules. The terms nobody owns decide what the negotiated terms are worth Executive Brief The contracts we review show clear signs of negotiation. Discount guarantees move. Rebate guarantees move. Dispensing fees, administrative fees, and performance guarantees move. Compare a PBM’s contracts across different employers and the pricing grids differ from client to client. But the governance language stays put. Audit scope, data ownership, rebate...
about 1 month ago • 6 min read
Your Contract Has No Exit Ramp 67 agreements. 27 PBMs. Zero extension clauses. Executive Brief I spent Friday at a conference talking with PBMs. They’re still receiving RFPs for January 1 starts. Several said the same thing: to implement on time, they need a signed contract in two weeks. That’s a tighter deadline than most plan sponsors think they’re working against, and the vendors know it better than the buyers do. Here’s what happens when a sponsor arrives at signature with two weeks of...
about 1 month ago • 6 min read
6 Weeks To Set The Next 3 Years The 90 Standard. Any size. Any sector. Executive Brief Most January 1 pharmacy contracts get signed in the next six weeks. The term will likely run three years. That's forty-two days of attention governing more than a thousand days of spend. For a 5,000-life employer at roughly $1,200 per member per year, the commitment can easily clear $20 million. The most valuable thing you can do with it takes one sentence and costs nothing. We call it "The 90 Standard."...
about 2 months ago • 6 min read
We Scored Mark Cuban's Contract Full Negotiation Report and Book Foreword, Both Free Executive Brief Something changed in the PBM market this year, and many plan sponsors haven't realized it yet. Ten PBMs have rewritten their standard contracts to score 90 or better on Contract X-Ray. Not one started there. All but one began in Red Flag, the lowest tier we score. The average improvement is 39 points. Nobody made them do it. No regulation requires a contract score, no enforcement action sits...
about 2 months ago • 8 min read
What Does It Cost You To Leave? Contracts either let you leave clean or clean you out Executive Brief A plan sponsor's leverage comes down to three things in sequence. You need your data. You need to be able to verify it. And if what you find is bad enough, you need to be able to leave. Break the last link and the first two stop mattering. An audit that proves you're being overcharged is a document, not a remedy, if leaving costs more than the overcharge. So we looked at what typical PBM...
about 2 months ago • 7 min read