By Jake Velie, Chairman & CEO, National Integrative Health

The most important sentence in some PBM paperwork is not buried in the pricing exhibit. It is not in the rebate schedule. It is not in the reporting package.

It is the disclaimer.

In one PBM pharmacy service agreement reviewed by our team, the language is direct: in providing services under the agreement, the PBM “is not acting as a fiduciary” under ERISA, and the client “shall not name” the PBM “as a plan fiduciary.”¹ That is not unusual. It is honest contract drafting. But it should get every self-funded employer’s attention.

Why? Because the plan sponsor still holds the liability, even while the PBM controls a huge amount of the machinery.

PBMs adjudicate claims. They build networks. They negotiate rebates. They issue reports. They manage specialty channels. They influence formularies and utilization patterns. But when it comes to fiduciary responsibility, many of them are telling employers exactly where they stand: not here.

What one PBM does well

To be clear, this is not a hit piece on any single company. The agreement and reporting package we reviewed show a PBM doing a number of operational things employers need done. 

The contract lays out claims processing, network administration, customer service, implementation support, audits, reporting, specialty pharmacy services, and rebate administration.² The fee schedule is straightforward enough to tell the client what it will pay for paid claims, prior authorizations, reporting requests, and other administrative functions.³ The agreement also states that the manufacturer’s rebate share to the client is 100%.³

The reporting itself is also the kind of visibility many employers say they want. The 2025 and Q1 2026 client summary reports show plan spend, member spend, rebates, net plan spend, generic utilization, specialty concentration, and other utilization markers.⁴ That is useful information. Employers need reporting. They need operational execution. They need a PBM that can keep the benefit running.

But here is the mistake too many plan sponsors still make: they confuse administration with alignment.

A clean report is not a fiduciary strategy. A rebate line is not a fiduciary strategy. A contract that spells out responsibilities is not the same as a partner taking fiduciary responsibility off your plate.

It does not.

The sentence employers cannot ignore

ERISA does not let a plan sponsor shrug and point downstream. The fiduciary standard follows the employer’s role in managing plan assets and plan decisions.⁵ If your PBM agreement says the PBM is not the fiduciary, believe it. 

That means the employer still owns the hard questions:

1. Are we paying the lowest net cost available for this drug?
2. Are rebate economics distorting our decision-making?
3. Are we overusing high-cost sites of administration?
4. Are there lower-cost biosimilar or therapeutic alternatives?
5. Are we using Manufacturer Assistance Programs (MAP), foundation support, and patient assistance opportunities where appropriate?
6. Do we have a documented process showing we evaluated those alternatives?
   

That last point matters more every year. The Consolidated Appropriations Act forced more disclosure into the pharmacy benefit system, but disclosure alone does not satisfy fiduciary duty.⁶ Transparency tells you where the problem is. You still need a solution.

Reporting does not equal optimization

The summary reports make the point for me.

In the 2025 report reviewed by NIH, specialty plan spend accounted for 71.6% of total plan spend.⁴ In Q1 2026, that figure rose to 88.1%.⁴ Those are not abstract numbers. That is concentration risk. That is exactly why employers cannot afford to look at pharmacy through a single-channel PBM lens.

Even with rebates reflected in the reporting, the employer still needs an independent strategy for where each claim should go and which levers should be pulled. If specialty utilization is dominating spend, the employer cannot be satisfied with getting a quarterly report and hoping the economics work themselves out.

At NIH, we take the opposite view. We assume every high-cost claim deserves to be challenged.

Where NIH changes the equation

National Integrative Health is not trying to become the PBM. We are the managed services layer that sits on the employer’s side of the table.

It is also important to be clear about what we are not. NIH is not the plan fiduciary. The employer still holds that responsibility. Our role is to help plan sponsors meet it with better oversight, better documentation, and better net-cost execution.

That matters because our job is not to protect a single channel. Our job is to drive the lowest net cost across all available channels.

That means looking at 340B pricing, biosimilar pathways, site of administration optimization, Manufacturer Assistance Programs (MAP), clinical interventions, foundation and patient assistance advocacy, and clinical trial access.⁷ ⁸ We are not dependent on a single regulatory outcome or a single vendor revenue model. We are focused on the employer’s result. 

So, when a PBM contract says, in effect, “we administer the program but we are not the fiduciary,” our response is simple: then the employer needs someone on its side who is actually waking up every day thinking like an owner. 

That is where NIH fits. 

This is a partner model, not a replacement fantasy 

Employers do not need to blow up their ecosystem to fix this problem. 

Brokers still matter. TPAs still matter. PBMs still matter. Auditors and consultants still matter. 

But each of those partners has a different role. 

Brokers connect plan sponsors to expertise. TPAs handle claims administration. PBMs process the pharmacy benefit and related operations. Auditors test the math and the compliance record. NIH helps the employer prove it asked the right questions, evaluated the right alternatives, and pursued the lowest net cost available.

That is the gap I see again and again in this market. Plenty of reporting. Plenty of vendors. Plenty of activity. Not enough employer-side orchestration.

Do not wait for the contract to save you 

If your PBM has already told you in writing that it is not the fiduciary, take that statement seriously. 

Do not wait for another lawsuit, another regulatory bulletin, or another renewal cycle to start building your fiduciary record. Start now. Review the contract language. Review the reporting. Review where specialty dollars are going. Then put a managed services strategy in place that proves you pursued the lowest net cost, not just the most convenient status quo. 

The employers who get ahead of this will not be the ones with the prettiest PBM dashboard. They will be the ones who can show they understood the risk, challenged the model, and acted. 

That is the standard now. And it should be. 

Jake Velie is Chairman & CEO of National Integrative Health, a managed services organization headquartered in West Des Moines, Iowa, specializing in prescription drug cost optimization for employer health plans.

Footnotes

1. PBM pharmacy service agreement reviewed by NIH, effective April 1, 2017, Article VI, Section 6.2. Source material on file.
2. PBM pharmacy service agreement reviewed by NIH, effective April 1, 2017, Exhibit A, Scope of Services. Source material on file.
3. PBM pharmacy service agreement reviewed by NIH, effective April 1, 2017, Exhibit B, Administrative Fee Schedule, including claims processing fee and manufacturer rebate share to client. Source material on file.
4. 2025 and Q1 2026 client summary reports reviewed by NIH. Source material on file.
5. Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002(21)(A), defining fiduciary functions under ERISA.
6. Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, Division BB, Title II, establishing prescription drug cost reporting and related transparency obligations for group health plans and issuers.
7. National Integrative Health, “About Us,” describing NIH’s managed services model for prescription drug cost optimization. https://nationalintegrativehealth.com/
8. Magellan Rx Management, “Medical Pharmacy Trend Report: Site of Care Optimization,” describing savings potential from shifting infusion administration to lower-cost settings.

By Jake Velie, Chairman & CEO, National Integrative Health

The momentum toward pharmacy benefit manager transparency just got a significant boost. As reported by Allison Bell in BenefitsPro on July 17, 2026, DOL Secretary nominee Keith Sonderling told the Senate Health, Education, Labor and Pensions (HELP) Committee that drafting new PBM transparency regulations is a priority for the Department of Labor.¹ The full hearing is available on the Senate HELP Committee’s website for anyone who wants to hear it straight from the source.²

“That’s going to save billions and billions of dollars for health care plans, which is going to drive down the cost of health care plans,” Sonderling stated during the hearing. He added that employers have “never been armed with information about what they’re paying for” and that “for the first time, they’re going to have that information.”¹

This is exactly the fight we’ve been in for years at National Integrative Health.

Why This Matters to Employers Right Now

For too long, PBMs have operated behind a curtain of complexity, profiting from spread pricing, rebate retention, and opaque formulary steering that costs plan sponsors billions annually. Sonderling’s commitment to transparency validates what we at NIH have built our entire model around: giving employers real visibility and real options to reduce their prescription drug spend.

This isn’t a new fight at the federal level. The Consolidated Appropriations Act of 2021 first cracked open the door by requiring group health plans to report prescription drug cost data and mandating PBM disclosure of rebates and fees.³ The DOL’s Transparency in Coverage Final Rule further required machine-readable pricing files from plans.⁴ And earlier this year, new federal PBM transparency laws created a collision with the DOL’s draft regulations that were already in motion, slowing the rulemaking process.⁵

Sonderling, who was confirmed as deputy secretary of Labor in March 2025 and became acting secretary after Lori Chavez-DeRemer resigned in April 2026,⁶ has now made it clear these regulations are back on the front burner. His oversight of the Employee Benefits Security Administration (EBSA), the agency that writes and enforces ERISA health plan rules, gives him direct authority to make this happen.⁷

At National Integrative Health, we don’t rely on a single strategy or hope that regulation will eventually fix the system. We deploy a multi-lever approach to achieve the lowest net cost on every claim, for every member:⁸

1. 340B Pricing: Access to the lowest U.S. source pricing available across all 50 states
2. Biosimilars: Therapeutic equivalents delivering 60–80% savings over brand medications
3. 503B Manufacturer Direct Contracting: Direct relationships with 503B outsourcing facilities for compounded specialty medications at a fraction of brand pricing
4. Proprietary 50-State Infusion Network: Our nationwide site of administration network redirects infusion and injection therapies from high-cost hospital outpatient settings to lower-cost, clinically equivalent alternative sites of care, saving plans 40–60% per administration⁹
5. Variable Copay Programs: Direct-to-manufacturer programs for GLP-1s and specialty medications
6. Clinical Interventions: Therapeutic substitutions, patient assistance programs, and provider coordination
7. Clinical Trial Program Access: Connecting eligible members to manufacturer-sponsored clinical trials, providing access to cutting-edge therapies to patients and large savings to plans in qualifying circumstances

This multi-channel model means we’re never dependent on any single regulatory outcome. If one lever faces headwinds, we pivot to the next-best option for the plan and the patient.⁸

Transparency Is Necessary, But Not Sufficient

While I applaud the DOL’s direction, employers shouldn’t wait for regulations to take action. Bell’s reporting notes that new draft or final regulations “may not come out in the next few weeks,” and that the department’s efforts have been slowed by the intersection of new congressional PBM transparency laws and existing draft regulations.¹ ⁵ When Sen. Bill Cassidy asked about a timeline, the best Sonderling could offer was, “We are working very hard on it.”¹

The reality is this: transparency tells you where the problem is. You still need a solution. That’s where a managed services organization like NIH comes in. We sit on the same side of the table as the employer, armed with clinical expertise and pricing intelligence across multiple channels, to ensure every dollar spent on pharmacy benefits is optimized.⁸

The Bigger Picture

As Sonderling moves through his confirmation process, his oversight would extend to ERISA-governed health plans, ACA employer provisions, and any new PBM legislation.¹ ⁷ These are the very regulatory frameworks that shape how employers structure and manage their health benefits. Having a Labor Secretary who views PBM accountability as a core priority signals a meaningful shift.

Sonderling also expressed enthusiasm at the hearing for creating benefit solutions for gig workers, programs that could let multiple platforms contribute to a worker’s benefit account without triggering employee classification under the Fair Labor Standards Act.¹ This signals a DOL that’s thinking creatively about expanding access to benefits, not just regulating existing ones.

At National Integrative Health, we welcome any effort to bring sunlight into the prescription drug supply chain. Transparency paired with actionable, multi-lever solutions is how we drive real savings for employers and better outcomes for their members.

The information age is finally reaching pharmacy benefits. It’s about time.

Jake Velie is Chairman & CEO of National Integrative Health, a managed services organization headquartered in West Des Moines, Iowa, specializing in prescription drug cost optimization for employer health plans.

Footnotes

¹ Bell, Allison. “DOL Secretary Nominee Calls PBM Transparency a ‘Priority.'” BenefitsPro, July 17, 2026. https://www.benefitspro.com/2026/07/17/dol-secretary-nominee-calls-pbm-transparency-a-priority/

² U.S. Senate HELP Committee. “Nomination of Keith Sonderling to Be Secretary of Labor.” Hearing recording. https://www.help.senate.gov/hearings/nomination-of-keith-sonderling-to-be-secretary-of-labor

³ Consolidated Appropriations Act of 2021, Pub. L. No. 116-260, Division BB, Title II (Transparency provisions requiring PBM disclosure of rebates, fees, and prescription drug cost reporting by group health plans).

⁴ U.S. Department of Labor, Department of Health and Human Services, and Department of the Treasury. “Transparency in Coverage Final Rule,” 85 Fed. Reg. 72158 (Nov. 12, 2020).

⁵ Bell, Allison. “Brand-New Federal PBM Laws Fuel Fight Over DOL Transparency Regulations.” BenefitsPro, Feb. 4, 2026. https://www.benefitspro.com/2026/02/04/brand-new-federal-pbm-laws-fuel-fight-over-dol-transparency-regulations/

⁶ Bell, Allison. “DOL Secretary Resigns, New Acting Head Has Been Active on Benefits.” BenefitsPro, Apr. 21, 2026. https://www.benefitspro.com/2026/04/21/dol-secretary-resigns-new-acting-head-has-been-active-on-benefits/

⁷ U.S. Department of Labor, Employee Benefits Security Administration (EBSA). https://www.dol.gov/agencies/ebsa

⁸ National Integrative Health. “About Us.” https://www.nationalintegrativehealth.com/

⁹ Magellan Rx Management. “Medical Pharmacy Trend Report: Site of Care Optimization.” Research shows that shifting infusion administration from hospital outpatient departments to physician offices, home infusion, or ambulatory infusion centers can reduce per-administration costs by 40–60%. https://www.magellanrx.com/medical-pharmacy-trend-report/

By Jake Velie, CEO & President, National Integrative Health

Caribou Systems recently published a piece that every self-funded plan sponsor should read: “You’re the Fiduciary. Can You Prove It?” It’s a direct, uncomfortable question, and that’s exactly why it matters.¹

Their argument is simple and correct: ERISA fiduciary compliance isn’t about outcomes. It’s about process. Specifically, can you produce an independent, time-stamped trail showing you were actively verifying your pharmacy benefit spend, catching errors, and acting on what you found? For most plans, the answer is still no.
 

What Caribou Does 

What Caribou Systems does is rare in this industry: they tell plan sponsors the truth about their exposure and then give them the tools to close the gap. Their re-adjudication engine audits 100% of pharmacy claims (not a statistical sample), they conduct 75+ pre-implementation audits annually, and they process over 200 million claims per year.² That’s not a compliance checkbox. That’s a real oversight infrastructure.

Their emphasis on independence is critical. As they correctly point out, PBM-provided reporting, however detailed, is not independent verification. The Consolidated Appropriations Acts of 2021 and 2026 gave plan sponsors the legal standing to demand raw claims data and expanded audit rights, but having data is not the same as having a defensible fiduciary record.³ ⁴ Caribou builds that record.

Where National Integrative Health Fits

At NIH, we view organizations like Caribou as natural allies. Our work operates on a parallel track: while Caribou ensures your PBM is billing correctly, disclosing rebates fully, and applying benefit terms accurately, NIH ensures you’re achieving the lowest possible net cost on every claim in the first place.⁵
 

We deploy a multi-lever approach: 340B pricing across all 50 states, biosimilars delivering 60–80% savings, site of administration optimization reducing infusion costs by 40–60%, variable copay programs for GLP-1s and specialty medications, clinical interventions, and clinical trial program access.⁵ ⁶

These aren’t competing strategies. They’re complementary layers of a complete fiduciary posture. Caribou asks: “Is your PBM doing what they said they’d do?” NIH asks: “Is the PBM model even the best structure for this claim?” Both questions must be answered.

The Litigation Environment Demands Both

Caribou’s article flags the ERISA lawsuits filed against Johnson & Johnson, Wells Fargo, and JPMorgan over health benefit mismanagement.¹ What those cases reveal is that courts don’t just want to see that you caught billing errors. They want to see that you exercised the care of a knowledgeable professional across the entire pharmacy benefit, including whether you explored alternatives to the traditional PBM markup model.
 

A plan that can show both an independent claims audit trail and evidence that it pursued the lowest net cost through multiple sourcing channels is in a fundamentally different position than one relying solely on PBM-provided reports and a broker’s annual review.

Don’t Wait for Regulation

DOL Secretary nominee Keith Sonderling has made PBM transparency a stated priority, and new regulations are in motion.⁷ But as I’ve said before: transparency tells you where the problem is. You still need solutions. The smartest plan sponsors aren’t waiting for regulators to hand them a playbook. They’re building their fiduciary record now, with partners like Caribou handling the audit and verification layer, and organizations like NIH driving the actual cost optimization.

Caribou Systems is doing important work. If you’re a self-funded plan sponsor and you can’t answer the five questions in their article, start there. Then call us to make sure the dollars flowing through that system are optimized from the ground up.

Jake Velie is Chairman & CEO of National Integrative Health, a managed services organization headquartered in West Des Moines, Iowa, specializing in prescription drug cost optimization for employer health plans.

Footnotes

¹ Caribou Systems. “You’re the Fiduciary. Can You Prove It?” MyHealthGuide, July 16, 2026.

² Caribou Systems. Company overview: audits 200 million+ pharmacy claims annually, conducts 75+ pre-implementation audits per year, and provides 100% claims re-adjudication for independent fiduciary documentation. https://www.caribousystems.com

³ Consolidated Appropriations Act of 2021, Pub. L. No. 116-260, Division BB, Title II (Transparency provisions requiring PBM disclosure of rebates, fees, and prescription drug cost reporting by group health plans).

⁴ Consolidated Appropriations Act of 2026 (Expanded audit rights and regulatory obligations for self-funded plan sponsors to act on pharmacy benefit data).

⁵ National Integrative Health. “About Us.” NIH is a managed services organization that deploys a multi-channel approach to achieve the lowest net cost on every pharmacy claim for employer health plans. https://www.nationalintegrativehealth.com/

⁶ Magellan Rx Management. “Medical Pharmacy Trend Report: Site of Care Optimization.” Shifting infusion administration from hospital outpatient departments to lower-cost settings can reduce per-administration costs by 40–60%.

⁷ Bell, Allison. “DOL Secretary Nominee Calls PBM Transparency a ‘Priority.'” BenefitsPro, July 17, 2026.

Client Snapshot: The Illinois Plan Sponsor Top 25 Reprice

An Illinois Plan Sponsor was facing a growing challenge with high-cost pharmacy claims. A small group of prescriptions was driving significant plan spend, and the company needed a clearer way to identify savings without disrupting employees who depended on these medications.

NIH analyzed 1,677 claims of The Illinois Plan Sponsor’s Top 25 high-cost prescriptions using the NIH MSO Network  and clinical cost-containment strategies, including:

·       Manufacturer Direct Contracting

·      Formulary Optimization 340B opportunities

·      Clinical Trials

·      503B options

·      Biosimilars

·      Therapeutic equivalence

·      Site of Care Optimization

·      The analysis also included a 20% rebate weight to reflect plan economics more realistically.

The Problem: High-Cost Pharmacy Spend with Limited Transparency

Like many employers and plan sponsors, The Illinois Plan Sponsor was dealing with rising pharmacy costs and limited transparency into whether prescriptions were being filled at the lowest possible net cost.

The client’s concern was not only cost. They also wanted to understand what would happen to members already taking high-cost medications.

Would members lose access?

Would they experience disruption?

How would they transition into a new pharmacy strategy without confusion or delays?

The core question was simple:

How do we bring costs down while making sure employees still receive the medications they need?

The Solution: NIH Technology, Repricing, and manufacturer direct contracting

NIH stepped in and provided a transparent repricing analysis to show the client where savings could be achieved immediately.

Through NIH’s technology-driven pharmacy solution, the client was able to see how high-cost drug spend could be reduced by identifying the lowest net cost of acquisition and applying smarter pharmacy management strategies.

NIH reviewed every member, every transaction, and every opportunity for savings. The solution included manufacturer direct contracting options, biosimilar strategies, and therapeutic equivalents where clinically appropriate.

This included:

·      Auditing claims for the lowest net cost of acquisition

·      Reviewing high-cost medications for generic, biosimilar, or therapeutic equivalent alternatives

·      Leveraging manufacturer direct, 340B, and 503B sourcing opportunities

·      Running a biosimilar and generic strategy where appropriate

·      Working directly with physicians when a lower-cost equivalent was available

·      Proactively communicating with members before disruption occurred

·      Managing the transition so employees continued receiving the medications they needed

The Savings: Lower Plan Spend and More Money Back to Members

The NIH reprice showed immediate and meaningful savings potential.

By analyzing 1,677 prescriptions across the Top 25 high-cost drugs, NIH identified that The Illinois Plan Sponsor could save:

$742,226.23 in plan savings

That represents a:

35.40% reduction in spend

In addition, NIH’s strategy would put:

$331,049.31 back into members’ pockets

This means the solution did more than reduce employer and plan costs. It also created meaningful savings for employees and their families.

The Member Experience: Seamless, Proactive, and Protected

One of The Illinois Plan Sponsor’s biggest concerns was the member experience.

NIH’s process was designed to be seamless. Members already taking high-cost medications were not left to figure things out on their own. Instead, they received proactive communication and support throughout the transition.

When a lower-cost generic, biosimilar, or therapeutic equivalent option was available, NIH worked with the doctor to help make the change in a clinically appropriate way. When a member needed to remain on a medication, the focus stayed on ensuring access while still managing cost intelligently.

The goal was never to take medications away from employees.

The goal was to make sure the plan was not overpaying for those medications.

The Result: High-Cost Drug Spend Came Down While Employees Stayed Protected

Using NIH’s technology, repricing tools, manufacturer direct contracting, and high-cost claim management strategy, The Illinois Plan Sponsor was able to identify substantial savings while maintaining access to critical medications.

The client gained:

·      Immediate visibility into potential savings

·      A projected $742,226.23 in plan savings

·      A 35.40% reduction in pharmacy spend

·      A projected $331,049.31 returned to members

·      A clearer understanding of where high-cost pharmacy spend was concentrated

·      A seamless implementation strategy

·      Better oversight of every pharmacy transaction

·      A smarter approach to biosimilars, therapeutic equivalents, and manufacturer direct contracting

·      Lower drug spend without unnecessary member disruption

The Takeaway

High-cost pharmacy spend does not have to remain unpredictable or uncontrollable.

With NIH, The Illinois Plan Sponsor moved from limited transparency and rising costs to a smarter, technology-driven pharmacy strategy that showed measurable savings from day one.

NIH did not just tell the client they could save money.

NIH showed the savings, identified the opportunities, and created a seamless path to bring high-cost drug spend down while ensuring employees continued to receive the medications they needed.

That is the power of one in-house team delivering a fully integrated managed care model.
Contact Information:

National Integrative Health
Jenny Jenkinsl, Global Brand Ambassador
jjenkins@nationalintegrativehealth.com
www.nationalintegrativehealth.com

San Antonio, TX — May 2026 — The Health & Voluntary Benefits Association (HVBA) officially kicked off its 2026 Innovation Summit in San Antonio with a full strategic board meeting, setting the tone for a high-impact event focused on leadership, innovation, meaningful networking, and partnership development across the health and voluntary benefits industry.

The San Antonio Innovation Summit brought together HVBA board members, sponsors, brokers, carriers, solution providers, and industry leaders for a curated experience designed to move beyond traditional conference networking. The event created an environment where attendees could engage in real conversations, explore case studies, ask thoughtful questions, and identify new opportunities to bring innovative benefit solutions to employers and their employees.

“HVBA events are intentionally designed to bring the right people into the room,” said Rob Shestack, President and CEO of HVBA. “Our goal is not just attendance. Our goal is connection, collaboration, and business outcomes. In San Antonio, we saw exactly that — meaningful introductions, strategic discussions, and partnerships already taking shape.”

Throughout the event, attendees participated in focused conversations around industry trends, benefit innovation, broker differentiation, and solutions that can be bundled, expanded, or offered as stand-alone opportunities. The summit highlighted how important it is for benefits professionals to hear real case studies, review data, and understand offerings in a way that supports stronger strategic decisions for brokers and their employer clients.

A key highlight of the event was the strength of the networking experience. Attendees left with more than business cards — they left with actionable next steps, new connections, and opportunities for future collaboration. HVBA’s curated format once again proved that smaller, high-value events can generate powerful results for attendees and sponsors alike.

The event also featured strong sponsor and speaker engagement, giving attendees direct access to companies and leaders bringing new ideas to the voluntary benefits and health benefits marketplace. The energy in the room reflected HVBA’s core mission: to create space where education, innovation, and relationship-building lead to real business growth.

With the success of San Antonio, excitement is already building for the next HVBA Innovation Summit, taking place Thursday, August 20, 2026, in Tampa, Florida. Attendees, sponsors, and partners from San Antonio are already looking ahead to continuing the conversations, expanding the partnerships, and building on the momentum created at this powerful event.

“Everyone left San Antonio energized,” Shestack added. “The conversations were strong, the connections were meaningful, and the business opportunities were real. We are thrilled that so many of our attendees and partners will be joining us again in Tampa.”

The HVBA Innovation Summit series continues to serve as a premier gathering place for professionals across the health, voluntary benefits, employee benefits, broker, carrier, and solution provider communities. Through strategic networking, education, sponsorship visibility, and curated access to decision-makers, HVBA remains committed to helping its members and partners grow, differentiate, and succeed.

About HVBA
The Health & Voluntary Benefits Association is dedicated to advancing education, innovation, networking, and strategic collaboration within the health and voluntary benefits industry. Through curated events, research, thought leadership, certification, and partnership opportunities, HVBA connects industry professionals with the insights and relationships needed to drive meaningful business growth.

Media Contact:
Jenny Jenkins
Health & Voluntary Benefits Association
jjenkins@vbassociation.com
www.vbassociation.com

Overland Park, KS – May 6, 2026: Allied National, one of the original pioneers in level-funded and reference-based pricing (RBP) healthcare plans, proudly announces the launch of Freedom Open Access, an end-to-end network alternative solution and bold reimagining of its decades-long commitment to affordable, transparent, and member-centric healthcare.

Background

Controlling ever-rising healthcare costs remains a challenge for many employers. The continued cost surge driven by a combination of rising prices for medical services and increased utilization raise affordability concerns for many small employers.

At the same time, navigating healthcare continues to be highly complex and fragmented for consumers who often feel lost and alone in that process.

Consumer focused innovation

Fortunately, solutions exist for employers to offer best-in-class benefits without the inflated costs. Allied National’s Freedom Open Access will be effective Aug. 1 and is data-driven, open-access solution powered by strategic direct contracts and pricing benchmarks above Medicare levels. It also features personalized member advocacy services supporting consumers to assist them in better navigating the complexities of healthcare.

The result: care that puts people first, meaningful cost savings and an enhanced healthcare experience.

Key Benefits of Freedom Open Access:

• Smarter Spending – Transparent pricing and strategic contracting deliver real value.
• Member Support – Personalized guidance and advocacy throughout the healthcare journey.
• Balance Bill Protection – Robust safeguards for members against unexpected costs.
• True Freedom of Choice – See any provider, anywhere. No more “in-network” vs. “out-of-network” confusion.
• Flexible Plan Designs – Tailored to meet today’s evolving healthcare needs.
• Market Differentiation – A forward-thinking solution for brokers and clients.

Media Contact: Contact Allied National at marketing@alliednational.com for an interview to learn more about the place of reference-based pricing plans like Freedom Open Access in a level-funded plan or visit www.alliednational.com/agentedge to see a copy of our Broker Guide for more information about the company’s enhancements to Freedom Open Access.

Learn about Allied National at www.alliednational.com.

New COO brings senior and benefits industry expertise to NIH’s leadership team

April 6th, 2026 – DES MOINES, IOWA. NIH is a fast‑growing consulting firm specializing in healthcare design, data, pharmacy, and analytics, helping employers better manage healthcare costs while improving care quality and access to personalized services for their employees.

NIH has named Joshua Ridgeway as its Chief Operating Officer. Prior to joining NIH, Mr. Ridgeway was Co-Founder and Chief Operating Officer for Rx-Precision, a genetics-based healthcare company pioneering one of the first Genetic Benefit Management platforms with groundbreaking innovation bringing personalized medicine into the self-insured space. Mr. Ridgeway was Founder & Managing Partner of National Health Advisors, leading a team dedicated to helping employers design self-insured health plans that lower costs, strengthen retention, and simplify benefit management. He will be responsible for leading NIH’s operational strategy and growth efforts in the healthcare market as NIH continues to scale its industry-leading solutions.

With NIH’s exponential growth in health plan management across the country, Robert S. Shestack has been promoted to Chief Enterprise Actuary while maintaining the role as NIH’s President. 

“We are pleased to have Josh join our executive team and leading the strategic operations of NIH,” said Jake Velie, Chairman & CEO. “Josh’s experience and knowledge speak for themself. His extensive experience and operational leadership make him an important part of our future growth. His insights and industry innovations will be a key addition in support of our continued success.” Jake Velie continues, “Having Rob lead our actuarial analytics division is an important step for NIH to provide our clients, stop loss carriers, and brokers the data they need to make important decisions while reducing stop loss premium renewals.”

Mr. Ridgeway has over 15 years of experience in strategic leadership roles in the healthcare space, across organizations such as Northwestern Mutual, Rx-Precision and National Health Advisors. He holds undergraduate degree in Communications and Business from Florida State University.

“I am excited to join the NIH team,” said Ridgeway. “I’ve been fortunate to join NIH and begin to collaborate with an exceptional team, build strong partnerships, and help create real impacts for clients and employees alike. What drives me most is helping people solve meaningful problems and see possibilities they didn’t know existed.”

About National Integrative Health

Since 2013, NIH has specialized in delivering innovative, highly effective clinical strategies directly to employers and their employees. Unlike traditional partners, NIH can integrate seamlessly into existing initiatives to expand impact and scope or design a program entirely from the ground up. In addition to its clinical strategies, NIH provides one‑stop healthcare delivery, provider case management, clinical consulting and engineering, 360° secure healthcare data solutions, and net‑zero funding. By doing so, NIH has helped clients save tens of millions in healthcare spend and serves Employers, Brokers, Pharmacy Benefits Managers, Population Health companies, Third‑Party Administrators, Healthcare Delivery Organizations, and Unions & Associations.

Contact Information:

National Integrative Health
Isabella Walles, Executive Assistant to the CEO
iwalles@nationalintegrativehealth.com
www.nationalintegrativehealth.com

San Antonio, Texas – HVBA today announced the upcoming HVBA Innovation Summit, taking place Thursday, May 21, at the renowned Hilton Palacio del Rio in San Antonio. Designed as a highly curated gathering of industry leaders, the Summit is redefining how the benefits community connects, collaborates, and drives innovation.

Unlike traditional conferences filled with massive expo halls and transactional booth visits, the HVBA Innovation Summit is intentionally structured to foster meaningful dialogue, strategic partnerships, and actionable outcomes.

A Different Kind of Industry Event

The Summit brings together the leaders shaping the future of benefits:

• Strategists delivering focus and clarity in a complex marketplace
• Innovators solving real employer challenges with forward-thinking solutions
• Connectors turning high-value conversations into lasting business relationships
• Visionaries defining what benefits will look like next year—not last year

Attendees can expect an environment free from the distractions of conventional trade shows. There are no endless exhibit aisles and no surface-level networking. Instead, participants will experience:

• Curated rooms designed for productive engagement
• Substantive “real talk” panels focused on industry realities
• Data-driven insights that provide a measurable competitive advantage
• Conversations that don’t just begin partnerships—they move them forward

Where Business Happens

HVBA’s approach is simple: every conversation matters. The Summit is built for leaders who are serious about innovation, collaboration, and measurable progress within the benefits space.

“Deals don’t start here—they happen here,” said an HVBA Brand Ambassador, Jenny Jenkins. “We’re creating an environment where the right people are in the right rooms, having the right conversations.”

Event Details

HVBA Innovation Summit
Thursday, May 21
Hilton Palacio del Rio
San Antonio, Texas

The 2026 Summit marks the beginning of a broader expansion of HVBA Innovation events, with additional programming and markets planned in the future.

Professionals interested in leadership, strategic growth, and meaningful partnership development within the benefits industry are encouraged to attend.

Sponsorship Opportunities Available

HVBA is offering multiple sponsorship tiers and branding opportunities, including:

• Summit Title Sponsor – $12,500
• Special VIP Dinner Sponsor – $7,500
• Networking Cocktail Reception Sponsor – $5,000
• Board Meeting Sponsor – $5,000
• Innovation Summit Presentation Slots (3 available) – $3,500
• Additional sponsorships ranging from $1,200–$4,000

For more information or to register, please contact events@vbassociation.com or visit https://www.eventbrite.com/e/2026-hvba-innovation-summit-san-antonio-tx-tickets-1982362073325?aff=oddtdtcreator.

About HVBA
HVBA is dedicated to advancing innovation, leadership, and partnership within the benefits industry through curated events and strategic collaboration platforms designed to create measurable business impact.

Mount Laurel, NJ — Tuesday, February 9, 2026 — The Health & Voluntary Benefits Association® (HVBA) today announced the appointment of Robert Lashley, President and Chief Executive Officer of ClickEnroll, to its Advisory Board. Lashley brings more than 30 years of leadership experience across insurance, benefits technology, artificial intelligence, and enterprise software development, further strengthening HVBA’s mission to advance innovation, collaboration, and best practices across the voluntary benefits ecosystem. 

A recognized industry architect, Lashley has built a career transforming complex, fragmented enrollment processes into scalable, data-driven platforms that improve engagement for employers, brokers, carriers, and employees alike. As founder and CEO of ClickEnroll, he has led the development of a next-generation benefits engagement and enrollment ecosystem designed to simplify decision-making, increase participation, and deliver personalized digital experiences through intelligent automation and modern architecture.

“Rob’s depth of experience and forward-thinking approach to benefits technology make him an invaluable addition to the HVBA Advisory Board,” said Robert Shestack, Chairman & CEO of the HVBA. “His leadership at the intersection of enrollment innovation, data standards, and human-centered design aligns closely with HVBA’s commitment to helping the industry evolve responsibly and effectively.”

Prior to founding ClickEnroll, Lashley held senior leadership roles at Manhattan Life and Humana, where he led enterprise enrollment transformation initiatives, electronic data interchange (EDI) architecture, and strategic integration partnerships within voluntary and group benefits divisions. Earlier in his career, he served as Chief Technology Officer of Falcon Technologies and as Vice President and Partner at TopLink Systems, architecting enterprise-grade platforms supporting enrollment, billing, claims, and administration for carriers nationwide. 

In addition to his executive leadership, Lashley is a founding member of the LIMRA Data Exchange (LDEx) standards committee and has played a formative role in shaping data integration frameworks that continue to influence interoperability and enrollment modernization across the industry. He is a frequent international speaker and trusted advisor to organizations spanning carrier, broker, union, and employer ecosystems. 

“I’m honored to join the HVBA Advisory Board,” said Lashley. “HVBA plays a critical role in fostering collaboration and thoughtful innovation across the voluntary benefits community. I look forward to contributing my experience and perspective to help advance solutions that benefit the entire ecosystem.”

Beyond his professional work, Lashley has supported numerous nonprofit and mission-driven organizations through technology consulting and strategic advisory roles, reflecting a longstanding commitment to community impact and service. 

About the Health & Voluntary Benefits Association® (HVBA)

The Health & Voluntary Benefits Association® is dedicated to advancing the voluntary benefits and healthcare industry through education, collaboration, and advocacy. HVBA brings together carriers, brokers, technology providers, and industry leaders to promote innovation, best practices, and sustainable growth across the health and voluntary benefits landscape.

Media Contact

Sarah M. Hunt
Senior Vice President, Administration
Health & Voluntary Benefits Association®
shunt@vbassociation.com
www.vbassociation.com

Last Week the DOL, Today Congress: PBM Transparency and Compensation Disclosure Requirements

As we told you on Friday, the DOL released proposed regulations requiring PBMs to disclose up to 8 “types” of compensation streams to a self-insured group health plan in accordance with ERISA’s section 408(b)(2)(B) Compensation Disclosure requirements (which you can read here, along with a 2-page summary of these proposed regs here).

And today, in a “1-2 punch” for PBM transparency, Congress enacted legislative language that would require a PBM to disclose to a group health plan, among other things, PBM payment practices including the receipt of rebates, price concessions, and “spread pricing,” along with the gross and net costs of prescription drugs in the PBM’s drug formulary, and other information like whether the PBM is dispensing covered drugs through PBM-owned pharmacies, mail-order, or specialty programs.  Below is a bullet-pointed list of information that PBMs must now disclose to the plan.

And to pile on, this legislative language also amended ERISA section 408(b)(2)(B) to delete the references to “Brokerage Services” and “Consulting,” and instead, clarified that any plan service provider that furnishes the “types of services” included in the statute’s enumerated “list of services” are subject to the 408(b)(2)(B) Compensation Disclosure requirements.  This amendment is intended to confirm that (1) PBMs that perform “pharmacy benefit management services” and (2) TPAs that perform “third-party administrative services” (both of which are “types of services” included in the statute’s enumerated “list of services”) are required to disclose “direct” and “indirect” compensation to a plan’s fiduciary in accordance with ERISA section 408(b)(2)(B).

And not to be outdone, this recently enacted legislation also requires a PBM to pass through 100% of the rebates paid to the PBM by a drug manufacturer to the plan itself.

The proposed regulations, and now this legislation, include industry-changing requirements, and only time will tell how transformative they may be.  We will keep you posted…

Bullet-Pointed Summary of Required PBM Transparency Disclosures

• Effective for the first plan year starting 30 months after the date of enactment, an entity providing pharmacy benefit management services (e.g., a PBM) on behalf of a group health plan must furnish to the group health plan every 6 months (or quarterly if requested by the group health plan) a report in a Machine-Readable Format with the following information relating to the prescription drugs covered under the group health plan:

• A list of covered drugs for which a claim was filed and the proprietary name and National Drug Code for each drug.

• The amount of compensation paid by the plan to the PBM for each covered drug.

• The amount of compensation the PBM paid to a pharmacy for each covered drug.

• The difference between the amount of compensation (1) paid by the plan to the PBM and (2) paid by the PBM to the pharmacy for each covered drug.

• The type of dispensing channel used to furnish each covered drug (e.g., retail, mail-order, or specialty).

• With respect to each drug dispensed through any of these channels, disclose (1) the “wholesale acquisition cost” (in the case of a brand-name drug) and (2) the “average wholesale price” (in the case of a generic drug).

• With respect to the brand-name and generic drugs, disclose (1) the original prescription and refill claims, (2) the participants and beneficiaries for whom a claim was filed through any one of the dispensing channels, (3) the dosage units and dosage units per fill, and (4) days supply of such drug per fill.

• The net price, after rebates, fees, or discounts received from a drug manufacturer, per course of treatment or single fill.

• The total amount of participant out-of-pocket spending for each covered drug.

• The total net spending for each covered drug.

• The total amount received, or expected to be received, by the plan from a drug manufacturer in rebates, fees, or discounts.

• The total amount received, or expected to be received, by the PBM from a drug manufacturer in rebates, fees, or discounts (1) for claims incurred and (2) related to utilization of a drug or spending on a drug.

• If applicable, the total amount of copay assistance, copay cards, or other discounts offered by each drug manufacturer to plan participants.

• A list of each “therapeutic class” for which a claim was filed and with respect to each such “therapeutic class” (1) the total gross spending on drugs in such class before rebates, price concessions, or discounts, (2) total net spending in such class after rebates, price concessions, or discounts, (3) total amount received, or expected to be received, by the PBM from a drug manufacturer in rebates, price concessions, or discounts for (a) claims incurred and (b) related to utilization of a drug or spending on a drug.

• The average net spending per 30-day and per 90-day supply by the plan among all drugs within the “therapeutic class” for which a claim was filed.

• The number of participants and beneficiaries who filled a prescription for a drug in such “therapeutic class,” including the National Drug Code for each drug.

• If applicable, a description of the formulary tiers and utilization mechanisms (e.g., prior authorization or step therapy) for the drugs in the “therapeutic class.”

• The total amount of participant out-of-pocket spending for the drugs in the “therapeutic class.”

• With respect to any drug for which gross spending under the plan exceeded $10,000 during the 6-month reporting period OR in the case that gross spending under the plan exceeded $10,000 during the 6-month reporting period with respect to fewer than 50 drugs:

• The highest gross spending for the 50 covered drugs under the plan.

• For the 50 covered drugs with the highest gross spending during the 6-month reporting period, (1) a list of all other drugs in the same “therapeutic class” as these drugs, (2) the rationale for the formulary placement of such drug in that “therapeutic class,” and (3) any change in formulary placement from plan year to plan year

• If the PBM providing services to the plan owns a pharmacy, or owns a mail-order or specialty home delivery program, or owns a retail and mail auto-refill programs, or provides cost-sharing assistance funded by the PBM, this PBM must:

• Provide an explanation of any benefit design parameters that encourage or require participants and beneficiaries to fill prescriptions at the PBM-owned mail-order, specialty, or retail pharmacies.

• Provide the percentage of total prescriptions dispensed by such PBM-owned pharmacies to plan participants.
• Provide a list of all drugs dispensed by such PBM-owned pharmacies to plan participants including (1) the amount charged to the plan per dosage unit or 30-day or 90-day supply, (2) the median amount charged to the plan and the interquartile range of the costs per dosage unit or 30-day or 90-day supply, including amounts paid by plan participants, when the same drug is dispensed by pharmacies NOT owned by the PBM, (3) the lowest cost per dosage unit or 30-day or 90-day supply for each drug, including amounts charged to the plan and participants, that is available from ANY pharmacy in the plan’s network, and (d) the net acquisition cost per dosage unit or 30-day or 90-day supply if such drug is subject to a maximum price discount.

If you have questions or comments, please contact Chris Condeluci at ccondeluci@siia.org or Anthony Murrello at amurrello@siia.org.

Source, Self-Insurance Institute of America, Inc., personal communication, February 3, 2026