Paul B. Holmes

Representative Matters: Paul has logged over 8,000 hours during the past 4-5 years, advising large employers and Taft-Hartley welfare funds managing their prescription drug benefit plans. This work includes active oversight of the RFP process for selecting a PBM, the negotiation of final PBM contracts (including pricing, rebates and audit rights), and regular audits of PBM compliance with their contracts.; Providing guidance on the customization of PBM drug formularies and PBM prior authorization protocols, to neutralize the PBMs' bias as the primary sellers of prescription drugs to a plan.; Providing guidance on 'deeper dive' audits of PBM pricing, rebates and claims processing compliance, as standard audit protocols are not all-inclusive.; Providing guidance on the selection of independent pharmacy benefit consulting firms (who do not receive indirect compensation from the PBMs), which independence is expressly required under Section 202 of Consolidated Appropriations Act of 2021 ('CAA').; Providing fiduciary training for the administration of large prescription drug benefit plans, including best practices regarding the RPF process, the negotiation of PBM contracts and the negotiation of pharmacy benefit consultant service agreements. These efforts are necessary to clarify vendor service obligations, obtain fair market pricing, avoid conflicts of interest, help control plan costs and otherwise protect plan fiduciaries.; Providing deep subject matter support to firm litigators in dispute resolution, arbitration and litigation against large PBMs and financially conflicted pharmacy benefit consultants.