Advisers may realize their work is not done once a pharmacy benefit plan is selected, but they may not be aware of the extent to which this is the case. Fiduciaries could be breaching their responsibilities under ERISA if the revenue streams going to PBMs are not fully understood by the sponsor.

Which begs the question: do your clients know about all the money you're making from their PBM relationship?

The broker industry has already been slammed by the contingent commissions scandal, still for many advisers and PBMs it is common practice to incent brokers to push pharmacy business to PBMs. Because the pharmacy benefit payment system is so cryptic, it's a natural veil for additional compensation.

"Conflicts [of interest] remain rampant in the consulting industry," says Linda Cahn, an attorney and president of Morristown, N.J.-based Pharmacy Benefit Consultants. "In fact, only a few weeks ago, my firm received a call from a PBM offering to pay my firm as much as $3.00 a prescription, if my firm would only 'bring business' to the PBM that had contacted us."

Cahn sees these negotiations as abusive practices. In an effort to rally advisers and employers behind transparent PBM contracts, PBC has created a conflict of interest disclosure form available for free download. Cahn's firm was able to draft the form because they have lawyers on staff.

She says many of the problems plaguing the health insurance industry are the result of conflicts of interest in which PBMS interfere with the consultant/employer relationship.

EBA wants to know what your experience has been with this issue -- are these practices as commonplace as some say? Should advisers be concerned? Email EBA Managing Editor Molly Bernhart with your questions and comments.