The Health Plan Compliance Advantage Newsletter
It’s Hard Out Here for a Fiduciary
It’s Hard Out Here for a Fiduciary Year-End Reality Check Being a fiduciary was never supposed to be easy. But...
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How to Get Real Value From This Newsletter
How to Get Real Value From This Newsletter Welcome! Let’s Get You Oriented. If you’re new(ish) or haven’t yet explored...
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Ends Tonight: Fiduciary Handbook Giveaway
Download Before They’re Gone Don’t Miss This (Deadline Tonight) Just a quick final reminder. Today is the last day to...
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Quick Reminder: Your Fiduciary Resources Are Waiting (Deadline Friday)
Your Fiduciary Resources Are Waiting Don’t Miss This (Deadline Friday) On Monday, I shared a set of gifts to mark...
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A Year of Writing. A Year of Purpose. Welcome to Issue #52
A Year of Writing. A Year of Purpose. Welcome to Issue #52 - A Milestone to Celebrate! 52 Week Giveaway...
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Legal Doesn’t Mean Ethical
Legal Doesn’t Mean Ethical Fiduciaries Should Know the Difference Executive Brief Let’s say the quiet part out loud:Rebates take money...
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Whose Money Is It, Really?
Whose Money Is It, Really? The Rebate Dilemma Why fiduciaries must confront the conflict no one talks about Executive Brief...
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The Rebate Trap
The Rebate Trap Why Employers Won’t Let Go And Why Fiduciaries May Not Have a Choice Much Longer Executive Brief...
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The PBM Breakup Letter
The PBM Breakup Letter Employers Are Moving On Employers are finally deciding to end their toxic relationship with PBMs that...
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Blueprints and Benchmarks
From model clauses to measurable proof, Nautilus is turning transparency into a standard everyone can trust.
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How Collective Action Fixes a Broken System
How Collective Action Fixes a Broken System The Fiduciary Network Effect Most employers still approach fiduciary reform as a solo...
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$45 Billion Biosimilar Wake-Up Call
f you don’t control your biosimilar strategy, your PBM will — and you’ll still be paying brand-name prices for generic...
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Twelve Steps of Fiduciary Recovery
Twelve Steps of Fiduciary Recovery Breaking Free From PBM Dependency Executive Brief Fiduciaries Anonymous is now in session. The first...
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Executives in the Dark
Executives in the Dark How to Get CEOs Asking the Right PBM Questions Executive Brief A Kaiser Family Foundation survey...
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No More Excuses: 10 Terms Every PBM Should Accept
A Contract Compliance RFI helps test your PBM’s willingness to meet legal and fiduciary standards
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PBM Reform Just Got Real
PBM Reform Just Got Real RFx Tools & Contracts You Can Use Executive Brief Employers are tired of PBM opacity....
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The Most Important Call Your CEO Hasn’t Taken Yet
The Most Important Call Your CEO Hasn’t Taken Yet Mark Cuban Is Ready to Dial In—Literally Executive Brief Why This...
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Lead with the Contract
Most PBM procurements get the sequence backwards: pick the PBM, then fight over the contract. That’s a recipe for weak...
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From Frustration to Fix: The PBM Field Guide
From Frustration to Fix: The PBM Field Guide We’re putting PBM procurement back in the hands of fiduciaries at RosettaFest...
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The Contract That Protects or Betrays
The Contract That Protects or Betrays When Fiduciary Duty Meets Contract Fine Print Most contracts protect the drafter. Healthcare vendor...
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PBM Procurement Without the Pain
PBM Procurement Without the Pain A New Open Source Tool to Cut Through Contracts, Conflicts, and Compliance Risks Executive Brief...
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When Fiduciary Duty Clashes With Civic Duty
When Fiduciary Duty Clashes With Civic Duty Should CEOs Join The Board Of A Hospital? Executive Brief You can’t serve...
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Popular Doesn’t Mean Prudent
Popular Doesn’t Mean Prudent The Hidden Risks of Voluntary Benefits—and the Fiduciary Blind Spot Letting It Happen Voluntary benefits may...
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Signed, Sealed… Sued?
Signed, Sealed… Sued? If You Didn’t Write the Contract, You’d Better Rewrite the Rules. Most health plan contracts come pre-written—by...
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The Death of Common Sense
When Five-Figure Pills Deliver Three-Week Benefits, Fiduciaries Must Intervene
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The PBM Reform Playbook
The PBM Reform Playbook State Legislatures Are Doing What Congress Hasn’t Executive Brief State legislatures are cracking down on PBM...
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PBM Illusions, Exposed
PBMs thrive on confusion. Bold employers are demanding receipts—and revealing just how costly that confusion really is.
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What Health Plans Haven’t Yet Learned from 401(k)s
What Health Plans Haven’t Yet Learned from 401(k)s Same law. Same risks. Bigger blind spots. Executive Brief The fiduciary failures...
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What I Learned from 25 Newsletters
What I Learned from 25 Newsletters And a Lot of Lawsuits Executive Brief Welcome to Issue #26 of The Health...
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The Fiduciary Lawsuit That Could Change Everything
The Fiduciary Lawsuit That Could Change Everything No More “We’re Just Administrators” TPA Defense Executive Brief Can a TPA avoid...
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Is Your Health Plan Killing the Corner Pharmacy?
Is Your Health Plan Killing the Corner Pharmacy? How employer decisions fuel pharmacy closures—and what you can do about it...
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Employers Say They Put People First
Employers Say They Put People First Until Someone Gets Sick When that spreadsheet-driven plan design causes delays, denials, or dropped...
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Why Companies Stick With Bad Vendors
Why Companies Stick With Bad Vendors The Psychology of Loyalty and the Legal Risk of Doing Nothing You’ve seen the...
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What Health Plan Lawsuits Reveal
What Health Plan Lawsuits Reveal And How to Stay Out of Them You may never find yourself in court over...
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Boardroom Risk Alert
Boardroom Risk Alert Fiduciary Failure Leads to Personal Liability Inflation, wage pressure, rising drug costs, and tariffs on products and...
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Compensation Disclosure
Compensation Disclosure Time for Brokers to Come Clean The world of employee benefits is changing—and so is the expectation around...
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Making Prudent Vendor Decisions
Making Prudent Vendor Decisions A Fiduciary and Strategic Imperative Here’s the uncomfortable truth: Many of the problems plaguing employer health...
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Why Employees Pay More for Prescription Drugs
Why Employees Pay More for Prescription Drugs What Can Employers Do About It? It’s a question every health plan sponsor...
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Smarter Approach to PBM Management
Smarter Approach to PBM Management The PBM Landscape The Big 6 PBMs—CVS Health, Express Scripts, OptumRx, Humana Pharmacy Solutions, MedImpact,...
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Rising Risk of Pharmacy Benefits
Rising Risk of Pharmacy Benefits Board Directors Are Now Named Defendants Recent lawsuits against major corporations highlight a growing risk:...
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Controlling Medical Benefit Drug Spending
Employers target PBMs to curb drug costs but often miss a big issue—specialty J-code drugs billed under medical benefits
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Mental Health Benefits
Adequate mental health benefits are a fiduciary responsibility and growing legal risk for employer health plans.
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Smart Shopping for Healthcare
Smart Shopping for Healthcare The Employer’s Role in Price Transparency Imagine running a business where employees make purchasing decisions without...
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Stop-Loss Insurance
Stop-Loss Insurance A Shield with Compliance Cracks Stop-Loss insurance protects self-funded health plans from catastrophic claims, but it comes with...
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Mastering Health Plan Contracts
Mastering Health Plan Contracts Are Your Contracts Hurting Your Plan? Many employers assume their health plan contracts are well drafted....
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Direct Contracting
Direct Contracting Game-Changer for Cost and Convenience Employers must find new ways to deliver high-quality, cost effective care. One strategy...
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Managing PBM Costs and Risks
Managing PBM Costs and Risks Key Issues for Plan Sponsors Pharmacy Benefit Managers (PBMs) claim to lower drug costs but...
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Health Plan Management Risks
Health Plan Management Risks Compliance Failure, Litigation, & Rising Costs Company health plans, often overlooked by boards, now represent a...
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The Advocate Adviser
The Advocate Adviser A Crucial Ally For Fiduciary Committees In the complex world of healthcare benefits, an Advocate Adviser is...
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Who Should Lead The Fiduciary Committee?
Who Should Lead The Fiduciary Committee? Strong Leadership Is Essential Fiduciary committee leadership is about balancing compliance, cost management, and...
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The Rise of the Fiduciary Committee
The Rise of the Fiduciary Committee First Retirement Plans & Now Health Plans For over two decades, 401(k) plan litigation...
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Health Plan Fiduciary 101
Health Plan Fiduciary 101 What’s It Mean To Be A Fiduciary? The Employee Retirement Income Security Act of 1974 (ERISA)...
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“Seething Public Discontent”
"Seething Public Discontent" A Catalyst For Action Although this newsletter has been in the works for months, I rewrote the...
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