The Rules Are Changing: What Employers Need to Understand About PBM Transparency, the Next Drug Wave, and How to Lead Through the Chaos

Description

Something fundamental is shifting in employer healthcare, and most benefits teams won't see it coming until it's already expensive. The Consolidated Appropriations Act's PBM transparency provisions, taking effect in 2028, will finally give employers full visibility into drug pricing, rebates, and utilization — but PBMs are already positioning to offset lost rebate revenue through administrative fees that are harder to see and harder to challenge. At the same time, direct-to-employer drug models, first tested with GLP-1s, are tracking to expand into other high-cost drug classes, meaning the coverage decisions employers make today will shape how much flexibility they have once the new rules land. This session goes beyond a standard trends panel: Dr. Uppal is actively co-authoring research on the CAA transparency provisions, Aaron Wurst brings deep operational knowledge of where the new pharmacy risks are hiding, and a leading benefits consultant will translate it all into what employers should be asking their PBMs and vendors right now. This isn't a session about what's trending — it's about what's coming in 2027 and 2028, and what separates the employers who lead through it from the ones who scramble to catch up.

Key Takeaways:

• A working understanding of the CAA PBM transparency provisions taking effect in 2028 — and the specific risks of PBM fee-shifting to watch for before it becomes entrenched 
• A forward look at where drug coverage models are heading, including how direct-to-employer models are evolving beyond GLP-1s and what that means for pharmacy strategy 
• What leading employers are doing today to position themselves ahead of the 2027–2028 policy and market shift -A practical framework for organizational readiness — what to put on the agenda now, what to defer, and what to stop doing

Includes HRCI CEU/SHRM PDC

About the Presenter

Dr. Nishu Uppal, MD, MBA, Medical Director

Dr. Uppal is a practicing internal medicine physician and healthcare policy researcher trained at Brigham and Women's Hospital. He has published in leading journals including NEJM, JAMA, and Health Affairs, and his research has informed federal healthcare legislation. He holds an MD from Harvard Medical School (Presidential Scholar) and an MBA from Harvard Business School.

Aaron Wurst, Pharmacy Advisor

Aaron was President of Truepill, a $500M+ digital pharmacy platform serving 600+ employees, where he led the company through 2.5x revenue growth and a $700M+ acquisition. Previously, he led pharmacy growth at CVS Health and served as Healthcare Lead at The Carlyle Group. He holds an MBA from Harvard Business School.