Quick Q&A: Jenny Goins on bringing PBM-style transparency to the medical side of benefits

The Department of Labor issued its final rule in late October setting disclosure and audit requirements for pharmacy benefit managers (PBMs) that serve self-insured employers and other self-insured groups. The rule, issued under the Employee Retirement Income Security Act, requires PBMs to disclose the compensation they receive to their empoyer clients and gives those self-insured plans the right to have their contracts audited (Read Managed Healthcare Executive's coverage of the rule.)

Jenny Goins was named interim president and CEO of the National Alliance of Healthcare Purchaser Coalitions in September 2026. The National Alliance represents self-insured employers. Goins spoke with Managed Healthcare Executive after the rule came out. She says the most important part of the rule for employers is visibility into how PBMs make their money, whether through fees, rebates or other sources.

But Goins says employers need the same visibility on the medical side of their benefit. Self-insured plans usually work with a third-party administrator and often use that administrator's claims system and provider network, she said, so employers also need to understand how those provider contracts work and where the money is going and coming from. "So that we understand and can really manage our fiduciary responsibility," Goins said.

Goins estimates that 20% to 30% of pharmacy costs come through the medical side of the benefit rather than through the PBM. Employers need the same kind of visibility into that spending, she said, and a process for health plans similar to the one the Labor Department just created for PBMs.