The U.S. Department of Labor’s Employee Benefits Security Administration announced a final rule on Thursday that seeks to rein in pharmacy benefit managers, a move several advocacy organizations are applauding.
Under the final rule, PBMs and their affiliates are required to disclose their fees and compensation to self-insured employers, including rebates from drug manufacturers and payments recouped from pharmacies. The rule also cracks down on spread pricing by requiring disclosure of compensation received when the price paid by the plan for a drug is more than the amount reimbursed to the pharmacy.
In addition, employers can audit these disclosures and can receive additional relief if a PBM doesn’t fulfill its responsibilities. The DOL projects that the final rule will lower prescription drug costs for health plans by up to $22 billion over 10 years.
“This is a win for every American worker who has ever paid too much at the pharmacy counter,” said Secretary of Labor Keith Sonderling in a statement. “For years, PBMs have operated in the shadows, pocketing hidden fees while workers and employers were left in the dark.”
The final rule comes after PBM reforms passed in the Consolidated Appropriations Act of 2026, which included the delinking of PBM compensation from the price of a drug in Medicare Part D and more detailed reporting to plan sponsors.
The ERISA Industry Committee (ERIC), an advocacy group for large employers, came out in support of the final rule, noting that it will bring transparency into PBM practices.
“Large employers pay for their workers’ prescriptions, but many can’t see how much of that money their PBM and any affiliated entity keeps,” said James Gelfand, president and CEO of ERIC. “This rule changes that. Employers will be able to check the numbers, ask hard questions, and hold their vendors accountable to the contract. This rule will fill a critical gap in the legislation Congress passed earlier this year, for the first time giving employers a real view into so-called ‘spread pricing’ arrangements and helping plan sponsors to improve the affordability of prescription drugs for working families.”
The National Community Pharmacists Association, which supports community pharmacists, also applauded the rule.
“The employers who pay PBMs to administer their health plans have been kept in the dark for many years when it comes to these fees and other forms of compensation. This new rule creates additional transparency for the first time,” said Ronna Hauser, NCPA’s senior vice president of policy and pharmacy affairs.
Meanwhile, a group representing PBMs argued that the rule threatens smaller PBMs and will raise costs for patients.
“The Department has made modest efforts to harmonize the rule with the recently enacted federal law, but we are concerned it may have exceeded Congress’s intent and its own authority. Patients, employers, and unions will have no new meaningful transparency from this action, but prescription drug benefits will now be more expensive. This could also lead to greater concentration in our industry as smaller PBMs face excessive reporting demands,” said David Marin, president and CEO of the Pharmaceutical Care Management Association.
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