US Labor Department finalises rule requiring PBMs to disclose fees to self-insured employer health plans

The Labor Department's Employee Benefits Security Administration (EBSA) published the final rule on 29 October 2026. It applies to pharmacy benefit managers (PBMs) that serve the self-insured group health plans of large employers, and to brokers and consultants affiliated with those PBMs. The department says such plans cover about 90 million Americans, but plan fiduciaries often cannot see what PBMs earn from other parties in the drug supply chain.

PBMs must now disclose three items for the first time: rebates and other payments from drug manufacturers; the margin they keep when a plan pays more for a drug than the PBM reimburses the pharmacy; and amounts recouped from pharmacies. Plan fiduciaries can audit the disclosures and get additional relief if a PBM does not meet its obligations. Healthcare Dive reported that the rule takes effect in July 2027, that PBMs must disclose when they negotiate or renew a contract and every six months after that, and that employers can audit once a year.

The department issued the rule under ERISA's prohibited transaction exemption for service providers and says it implements transparency reforms in the Consolidated Appropriations Act, 2026. It projects that the rule will lower prescription drug costs for plans and participants by as much as $22bn, undiscounted, over ten years. Healthcare Dive reported a department estimate of $1m in first-year compliance cost per PBM and $300,000 a year after that.

Labor Secretary Keith Sonderling called the rule a win for every worker who has "paid too much at the pharmacy counter". The Pharmaceutical Care Management Association, which represents PBMs, called it "a solution in search of a problem", Healthcare Dive reported. PBM groups had argued in consultation comments that the department lacks the legal authority to require the disclosures.