Today’s episode features David Schryver, Pharm.D., and Ron Romano, RPh
Legislative landscape surrounding healthcare is constantly evolving. Some rules and regulations may have unintended consequences affecting plan sponsors and their members. On this episode of the Stay in Check Podcast, ProAct’s President, David Schryver, sits down with ProAct’s Director of Regulatory and Compliance, Ron Romano, to discuss the impacts of upcoming legislation and what could be expected.
"The biggest thing of [CAA 2026] is related to PBM reform," says Ron Romano. "[It surrounds] contract language, PBM reporting requirements, audit rights, and other things ... but it's going to result in more transparency.
In the PBM space, transparency can have many different meanings. "True transparency," says Ron Romano, "is getting through the dollars and cents, and where those plans costs really ... affect not only the plan sponsors but ... their members."
Formal rulemaking will be coming down the pipe in early 2027, but who's making the rules? "We've seen a lot ... on the state level, individual states trying to mandate what a PBM can do," says David Schryver. "Historically ... federal law [has been] the law of the land," says Ron Romano, "if a state decides to push ... in a more aggressive fashion ... you could see more responsibility [on the PBM]."
Driven by an Executive Order by President Trump, the proposed DOL rule will "give more insight ... into what's driving [plan] cost," says Ron Romano. " PBMs will need to provide both a machine-readable file and what they call a plain language format ... that's a big undertaking ... to take something that's new, with all these different aspects, that need to be reported on ... that would be an administrative cost for the PBM."
"We hear a lot [in the industry] that the PBMs, as middlemen, are responsible for setting the drug price ... it's always been a fascinating discussion for me," says David Schryver - knowing that it's not an accurate assessment.
Some states are putting laws into place surrounding vertical integration that could affect the health outcomes of rural Americans. "[Forced pharmacy closures] lead to a gap in care," says David Schryver, "it's leading to situations occurring, where we talk about pharmacy deserts."
View the full podcast “PBM Reform - What's Really Changing”
Contact your dedicated Account Manager or Sales Director for more information.
Don't know who to reach out to? Contact us here.
