University of Illinois College of Law, J.D.
Bradley University, B.S., magna cum laude
Paul B. Holmes | Partner
Paul is a seasoned ERISA lawyer with nearly 40 years of specialization in that field. Paul joined the firm recently, after 31 years with Nixon Peabody LLP and Ungaretti & Harris LLP. Paul has extensive and unique experience in representing large employers and Taft-Hartley welfare funds in their selection, contracting, auditing and litigation with large pharmacy benefit managers ("PBMs").
Education
Bar Admissions
Illinois
U.S. District Court, Northern District of Illinois
U.S. Tax Court
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.
Memberships
Certified Public Accountant
Recognitions
Selected, through a peer-review survey, for inclusion in The Best Lawyers in America© 2020 and 2021 in the field of Employee Benefits (ERISA) Law
A/V Rated, Martindale-Hubbell, 2008-2023
2003–2023 Illinois Leading Lawyers Network—Employee Benefits/ERISA/Executive Compensation