Legislative Compliance

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Ensuring PBM Agreements Meet the Highest Standards of Regulatory Compliance

In an ever-evolving regulatory environment, plan sponsors must proactively adapt to ensure their PBM agreements comply with the latest legislative mandates. At PBM NEGOTIATOR™, we provide comprehensive legislative compliance services, helping plan sponsors navigate complex regulations while minimizing legal and financial risks. Our approach promotes transparency and accountability within PBM contracts, ensuring that agreements align with the highest standards of fiduciary responsibility. With deep expertise in federal and state PBM reform laws, we empower plan sponsors to strengthen compliance, eliminate unfair pricing practices, and protect plan participants

Mastering Legislative Complexity

PBM contracts often contain opaque pricing models, ambiguous rebate structures, and non-transparent cost-sharing provisions that must be carefully reviewed to align with evolving legislation. Our legal team has decades of experience in ERISA, health plan law, and PBM contract negotiations, ensuring that agreements are meticulously assessed and updated to reflect current compliance requirements. Our legislative compliance service includes:

Comprehensive Compliance Audits: We conduct a thorough review of existing PBM agreements, identifying non-compliant provisions, hidden fees, and pricing practices that could expose plan sponsors to fiduciary risks.
Application of Key Legislative Provisions: We ensure that PBM contracts comply with new federal and state regulations, including laws restricting spread pricing, enforcing rebate transparency, and eliminating non-disclosed administrative fees—creating a fairer, more accountable framework for plan participants.
Updates and Revisions: Our team incorporates necessary amendments to address current and upcoming regulatory changes, ensuring that PBM agreements remain compliant, cost-efficient, and aligned with plan sponsors’ fiduciary obligations.

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Years of Experience

Our collective experience delivers consistent results.

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Cases

Relevant matters and negotiations, prepared for all the possibilities.

The Benefits of a Proactive Approach

By engaging PBM NEGOTIATOR™’s legislative compliance services, plan sponsors benefit from a proactive, in-depth approach that goes beyond standard legal reviews. Our compliance solutions are designed to identify and correct contract vulnerabilities, ensuring PBM agreements align with evolving regulations. Here’s what sets our compliance services apart:

Risk Mitigation: Avoid regulatory penalties and fiduciary liabilities through a comprehensive assessment that detects pricing irregularities, non-compliant rebate structures, and transparency gaps.
Enhanced Confidence: Trust that your PBM contracts adhere to all legal requirements, ensuring peace of mind and reinforcing your fiduciary responsibilities as a plan sponsor.
Long-Term Stability: Protect your organization from future regulatory changes by incorporating flexible, forward-thinking compliance measures that ensure contract adaptability.

Delivering Positive Outcomes

Our legislative compliance expertise has delivered substantial financial and operational benefits for plan sponsors. For example, we successfully assisted a large self-funded employer in restructuring their PBM contract to meet new federal and state transparency mandates. This resulted in greater rebate disclosures, elimination of hidden fees, and improved cost accountability. Not only did this safeguard the client from compliance penalties, but it also enhanced their position as a responsible plan sponsor committed to financial transparency.

Partner with PBM NEGOTIATOR™ for Compliance Excellence

Staying compliant with evolving PBM regulations is more than a legal necessity—it’s a strategic advantage. At PBM NEGOTIATOR™, we ensure your PBM agreements reflect the latest legal standards, empowering you to maintain compliance with confidence. Our dedicated team works closely with you to align your contracts with both current and emerging regulations, fostering transparency and trust among plan participants.

Ready to elevate your compliance standards? Contact PBM NEGOTIATOR™ today to learn how our legislative compliance services can protect and enhance your pharmacy benefits strategy.

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