Radar on Drug Benefits

PBM Industry Could Face Major Challenges From ERISA Suits

  • Feb 22
    Popup Image

    Feb 22, 2024

    A lawsuit filed by an employee against Johnson & Johnson could signal that significant changes in the legal obligations of commercial plan sponsors and PBMs around drug pricing are coming, experts say. The suit alleges that J&J violated its fiduciary obligations as a health plan sponsor under the Employee Retirement Income Security Act (ERISA) of 1974 by overpaying the plan’s PBM for employees’ medications.

    If it’s successful, the suit could expose plans, plan sponsors and PBMs to significant, ongoing legal risk, experts say. However, they add that the opacity and complexity of drug pricing dynamics mean that the suit’s success is far from certain.

    Read more
      • Radar on Drug Benefits
    © 2024 MMIT

    • Peter Johnson

    Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

    Back to Radar on Drug Benefits

Related Posts

The Latest
Premium Categories
Meet Our Reporters

Lauren Flynn Kelly

Executive Editor, AIS Health, and Managing Editor, Radar on Medicare Advantage

View Lauren Flynn Kelly's Profile

Angela Maas

Managing Editor, Radar on Specialty Pharmacy and Spotlight on Market Access

View Angela Maas's Profile

Leslie Small

Managing Editor, Health Plan Weekly and Radar on Drug Benefits

View Leslie Small's Profile

Tim Casey

Reporter, Health Plan Weekly and Radar on Drug Benefits

View Tim Casey’s Profile

Carina Belles

Reporter, Radar on Medicare Advantage and Spotlight on Market Access

View Carina Belles's Profile

Jinghong Chen

Reporter, Health Plan Weekly and Radar on Drug Benefits

View Jinghong Chen's Profile

Jill Drachenberg

Reporter, Health Plan Weekly and Radar on Drug Benefits

View Jill Drachenberg's Profile

Meet Our Reporters

Lauren Flynn Kelly

Executive Editor, AIS Health, and Managing Editor, Radar on Medicare Advantage

View Lauren Flynn Kelly's Profile

Angela Maas

Managing Editor, Radar on Specialty Pharmacy and Spotlight on Market Access

View Angela Maas's Profile

Leslie Small

Managing Editor, Health Plan Weekly and Radar on Drug Benefits

View Leslie Small's Profile

Tim Casey

Reporter, Health Plan Weekly and Radar on Drug Benefits

View Tim Casey’s Profile

Carina Belles

Reporter, Radar on Medicare Advantage and Spotlight on Market Access

View Carina Belles's Profile

Jinghong Chen

Reporter, Health Plan Weekly and Radar on Drug Benefits

View Jinghong Chen's Profile

Jill Drachenberg

Reporter, Health Plan Weekly and Radar on Drug Benefits

View Jill Drachenberg's Profile

Tags
Court Cases
Drug Pricing
ERISA
Employer Group Health Plans
PBMs/Pharmacy Benefit Managers
×

PREMIUM CONTENT AND PREMIUM INSIGHTS

To gain access to this article you need to have a Premium Subscription.
Click the link below to access today!