Brandon Kessler of Milliman on heightened attention to fiduciary responsibility | PBMI 2026

Employee lawsuits alleging that health plan sponsors failed in their fiduciary duty to secure favorable pharmacy benefit terms have become more common in recent years, and much of that mistrust traces back to how confusing prescription drug pricing can look from the outside, according to Brandon Kessler, principal and product owner at Milliman. Kessler discussed the trend in an interview yesterday with Managed Healthcare Executive after appearing on a panel discussion, “From Trust to Proof: The New Fiduciary Standard for Pharmacy Oversight.”

Part of the wave of litigation, Kessler said, grew out of some employees’ sense that employers were signing pharmacy benefit contracts without closely scrutinizing what those plans actually delivered — effectively rubber-stamping agreements rather than evaluating them.

Pharmacy pricing complicates the picture further, according to Kessler. Because pricing structures differ so greatly, the cost of an individual drug can vary enormously from one plan to another, and that disparity is easy to cherry-pick. An employee who notices that a single prescription would have been far cheaper elsewhere, he said, may not realize that other drugs — or the plan as a whole — would have cost far more.

That kind of misalignment, Kessler said, has left many employees suspecting that employers are shifting costs onto them through rising premiums and deductibles rather than acting in their best interest.

Kessler was joined on the panel by JT MacMannis, vice president of business development at Milliman, and Andrew Timcheck, a principal and consulting actuary at Milliman.