Brandon Kessler on advice to employers about meeting their fiduciary responsibility | PBMI 2026

Employers were used to pretty much ignoring their pharmacy benefits, according to Brandon Kessler, a principal at Milliman. But lawsuits and a new focus on fiduciary responsibility are changing that.

“Now it's, ‘ How am I doing? How is the contract progressing?’ And it's getting from a three-year cycle down to at least need to be doing annual audits,” Kessler said in an interview yesterday with Managed Healthcare Executive (MHE) at the 2026 Pharmacy Benefit Management Institute Annual National Conference in Orlando, Florida.

Kessler said employers and other payers have to be prepared to deal with what are mistakes when dealing with pharmacy benefits and to respond quickly if need be.

“We're human. Mistakes happen. Can you quickly adjust them? Can you reduce the number of members who are impacted? And can you also adjust the impact that it would have to the employer spend?” he said.

Part of the challenge, Kessler said, is that pharmacy benefits are not standardized. Even basic terms, such as “brand" or “generic,” can be defined differently from one pharmacy benefit manager (PBM) to the next or even within the same PBM. Closing that gap starts with helping plan sponsors and employees alike better understand what their benefit actually covers and what they are getting out of their PBM contract.

Kessler also advises employers not to be overly concerned by the prospects of lawsuits. Employers ask, he said, what they can do not to get sued. “I think part of it is saying, ‘Lawsuits are going to happen.’ But what we can do is try to mitigate them whenever possible.”

Kessler spoke with MHE after appearing on the panel “From Trust to Proof: The New Fiduciary Standard for Pharmacy Oversight" at the Pharmacy Benefit Management Institute's 2026 Annual National Conference in Orlando, Florida. He was joined on the panel by JT MacMannis, vice president of business development at Milliman and Andrew Timcheck, a principal and consulting actuary, also at Milliman.