January reveals who is willing to keep living with it.
Every year, health plan fiduciaries face the same quiet decision. Will this be the year they challenge conflicts hiding in plain sight?
Or the year they let them keep running in the background.
After a year of legal false starts, regulatory noise, and “transparent” solutions that were anything but, one truth stands out:
Employers are not powerless.
They have simply been trained to act like they are.
You choose who advises you. You choose how vendors are paid. You choose whether fiduciary duty is real or performative.
This issue is a reset. A set of practical fiduciary resolutions for leaders who want 2026 to look different.
No theory. No waiting. Just actions you can take now.
2026 Reset
Ten Fiduciary Resolutions for 2026
1. Start With Disclosure. Every Vendor. No Exceptions.
If you do only one thing this year, make hidden money visible.
Require written compensation and conflict disclosures from: • Brokers and consultants • PBMs • TPAs • Stop-loss vendors • Any intermediary touching plan dollars
Not summaries. Not “available upon request.” Actual numbers. Actual relationships.
You can’t manage conflicts you can’t see.
2. Treat Rebates as a Fiduciary Decision
PBMs are looking for new ways to monetize you.
Rebates didn’t disappear in 2025.
They just got quieter.
In 2026: • Identify who actually funds rebates (hint: your sickest employees) • Map who benefits from them
• Determine if your PBM is making their own drugs (e.g., biosimilars) • Model lowest net-cost alternatives • Document why you keep or move away from them
Moving to net-cost pricing takes time.
Ignoring rebates is no longer defensible.
3. Lead With Contracts, Not Promises
If it’s not in the contract, it’s not real.
This year: • Inventory every vendor agreement • Identify missing audit rights, data access, and termination provisions • Compare language to fiduciary-aligned standards • Renegotiate where gaps exist
Good intentions never survive bad contracts.
4. Build Collective Leverage. Share Your Contracts.
Acting alone can feel safe. It also keeps you weak.
In 2026: • Use tools like Nautilus Contract X-Ray to identify systemic risks • Contribute anonymized contracts for comparison • Participate in shared benchmarking • Help define standards others can adopt
Collective transparency creates leverage.
5. Re-Clarify Fiduciary Roles and Authority
Assumptions are not governance.
This year: • Confirm who is a fiduciary and who is not • Document decision authority • Align committee charters with ERISA reality • Stop treating fiduciary duty like meeting attendance
Accountability starts with clarity.
6. Build a Fiduciary Calendar You Actually Use
Compliance fails when it is reactive.
Create a calendar that includes: • Contract reviews • Vendor performance reviews • Audit checkpoints • Fiduciary training • Documentation milestones
Consistency beats perfection.
7. Make Defensibility a First-Order Goal
Risk shows up long before lawsuits do.
Courts may never reach the merits.
But discovery, reputational risk, and board scrutiny are very real.
Ask this year: • Can we explain this decision clearly • Can we show our work • Can we defend this under scrutiny
Process is protection.
8. Monitor What Actually Drives Cost and Risk
Dashboards that impress rarely protect you.
Focus on: • Vendor performance vs. promises • High-cost claim patterns • Pharmacy trend drivers • Site-of-care decisions • Denial and appeal data
Oversight is an active obligation.
9. Invest in Fiduciary Education
Training should change behavior, not satisfy a checkbox.
In 2026: • Educate committees on real fiduciary risk • Connect legal duty to operational decisions • Focus on PBM contracts and conflicts • Align education with documentation
Informed committees make defensible decisions.
10. Commit to Progress, Not Perfection
Perfection is not required. Seriousness is.
But you do need to: • Acknowledge conflicts • Document a path forward • Show steady, intentional progress
Fiduciary duty rewards seriousness.
A Final Word for 2026
This year doesn’t require grand reform. It requires leadership.
The employers who make real progress will not be the loudest.
They will be the ones who quietly: • Demanded disclosure • Rewrote contracts • Questioned rebates • Documented decisions • Refused to outsource responsibility
That work is not easy.
But it is clear, defensible, and fully within your control.
Welcome to 2026. Let’s do the work.
Next Step: A Discount for All Subscribers
If you want practical tools to support this work, that’s why I created The Fiduciary Handbook and the certification program. To help employers act, not wait.
Time Running Out On This Special Offer If you didn’t win one of the five free seats to the Certified Employer Fiduciary Course you can still get 50% OFF through the end of this year. Use the FIDUCIARY50 discount code at checkout from the Validation Institute at https://tinyurl.com/ERISAFIDUCIARY.
Certified Employer Fiduciary Course
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