In the world of modern health care, Catholic dioceses struggle to offer comprehensive medical care because health insurance plans commonly provide coverage for immoral procedures such as contraception, sterilization, and so-called gender-affirming management. Thankfully, Catholic pharmacy benefits managers exist to help bishops navigate the murky waters of government regulation and misleading diagnoses—and help dioceses save money while they’re at it.

In episode 105 of Bioethics on Air, “Preserving Catholic Identity and Ethics in Employee Health Plans,” Joe Zalot interviews Robert Smedley on the topic of Catholic health care. Smedley is the president of Matthias Group, a health care management organization that aims to help Catholic dioceses navigate the complexities of pharmaceutical management and strategy. The interview was insightful, especially for an audience that knows nothing about the unique difficulties posed to the Catholic Church and its institutions by the modern health care system.

In the American medical system, health benefits plans often violate Church teaching. Seeing these violations as a Judas-like betrayal of medical and moral principles, the Matthias Group was formed and took its name from St. Matthias, who was chosen to replace the seat left vacant by Judas. The group serves the Church by replacing these problematic, secular health care plans with robust ones in accord with Catholic principles.

Smedley sees his role in the Matthias Group as a mission focused on improving dioceses’ options for pharmacy benefits managers (PBMs), third-party intermediaries acting between employees, their pharmacies, and their employer’s insurance company. As he explains, even though “you have a drug benefit” in your insurance plan involving a copay, the insurance company does not manage those copays. Instead, insurance companies offshore this task  to a third party.

PBMs present unique moral challenges for Catholic dioceses, partly because they tend to be motivated by greed. Smedley jokingly refers to them as “profits before morals.” It becomes apparent throughout the interview that the moral problems of PBMs range from the nature of the medicine and its use to the financial practices of pricing medicine—a matter of moral integrity and greed.

According to Smedley, the largest problem on the pharmaceutical side of health care finances is the rising cost of specialty drugs, which constitute about 50 percent of an employer’s cost, although they are used by only 2 percent of employees. In a striking example of financial immorality rampant in PBMs, Smedley recounts his work renegotiating an archdiocese’s plan from eleven to seven million dollars. The bishop and CFO flatly asked him if they had previously been ripped off. Smedley answered them frankly, “Yeah, pretty much! … That was what the market allowed and that was what they charged. Sorry!”

Clearly, greed presents a significant hurdle for providing Catholic health care. Tragically, the problems go deeper. From the ethical standpoint, Smedley and Zalot identify two major and looming problems for the Church. First, state and federal governments increasingly are attempting to redefine staples of natural law—notably, marriage. Smedley laments the tendency of Catholic contracts to blindly assume the same definitions of marriage as used by the state and federal government. Dioceses will need to change the language used in their contracts to better stand by their natural understanding of marriage. For example, he suggests “saying ‘cite to Canon 1055’ and ‘Cite to Genesis.’”

The second looming problem is more straightforwardly moral but also more insidious: “Federal governments, state governments are mandating that health care plans provide coverage for interventions that violate Catholic teaching,” says Smedley. Physicians commonly fabricate medical necessities for many desired interventions as a means to sneak past preauthorization requirements. Smedley gives the example of Lupron, which was originally designed to treat precocious puberty but has been increasingly prescribed to facilitate gender transitioning. To counter this problem, Smedley suggests incentivizing plans to receive prescriptions through Catholic-friendly clinics that will not seek to evade preauthorization requirements.

The ideal driving his suggestion is profound yet simple. Any plan implemented by a diocese must be based on both truth and compassion. Smedley rightly claims that “we are a loving Church that supports family and care.” We must never reduce our desire to protect the Church’s teaching to mere reactionary defense. Truth must be wedded to compassion such that the plans that dioceses implement promote genuine care. According to Smedley, it is incumbent on bishops to both defend the faith and promote the good of those they serve.

To navigate the muddy waters of health care in a secularizing world, bishops must not be afraid to audit their dioceses’ health care plans. This may require close, line-by-line reading to clarify what does and what does not meet with Church teaching. Importantly, Smedley explains that a genuine audit will be motivated by both truth and compassion. By way of warning, he gives the example of a diocese unwilling to provide any fertility treatment to its employees out of fear of violating Church teaching, even though many fertility treatments are in line with Church teaching. Tragically, the diocese overreached its defense of Catholicism by neglecting to care for those it served.

Certainly, PBMs are difficult to operate in accord with Church teaching, but not impossible. Smedley rightly points out that bishops need to dedicate themselves to hard work and careful planning. Missions like the Matthias Group exist to help them.

 Colten Maertens-Pizzo works for the Archdiocese of Chicago Catholic School System.