Is Your PBM a Fiduciary Risk? The Cigna Question

Litigation involving pharmacy benefit managers and their affiliated health plans has put a sharp question to plan sponsors: can you document how your PBM was selected and how it is overseen? Increasingly, sponsors are expected to treat that process like investment-manager due diligence.

The concern is structural. When a PBM earns more as drug spend rises — through spread pricing, rebate retention, or steering to an affiliated pharmacy — its incentives can diverge from the plan's. ERISA does not forbid the conflict; it requires the sponsor to understand and manage it.

That means reading the contract for what it actually permits, testing rebate pass-through and formulary construction against a market standard, and recording the review. Regency evaluates PBM arrangements independently and fee-only, beholden to no PBM, carrier, or fund family — unconflicted analysis built around the plan, so the assessment answers to the plan and no one else.