Federal Rule Makes Pharmacy Benefit Manager Fees Easier to See
Published Date: 11/2/2026
Rule
Summary
Starting July 1, 2027, big self-insured health plans must get clear info on fees from pharmacy benefit managers (PBMs) and related brokers. This rule helps plan leaders see if PBM fees are fair, aiming to cut surprise costs and boost transparency. It’s a win for employers trying to manage rising drug expenses and keep healthcare affordable.
Analyzed Economic Effects
4 provisions identified: 3 benefits, 1 costs, 0 mixed.
PBMs must disclose compensation to plan fiduciaries
If you are a sponsor or fiduciary of a large, ERISA-covered self-insured group health plan, providers of pharmacy benefit management services (PBMs) and affiliated brokers/consultants must give you detailed disclosures of their compensation for services and advance disclosure of compensation they reasonably expect to receive. The final rule is effective January 4, 2027 and applies to plan years beginning on or after July 1, 2027.
Congressional rebate pass-through requirement (2028)
Congress provided that, effective for plan years beginning on or after August 3, 2028, PBMs must pass through rebates, fees, alternative discounts, and other remuneration received from drug manufacturers and other entities to the group health plans they serve (or to issuers on behalf of plans).
Disclosures required to meet ERISA exemption — compliance risk
The disclosures required by the final rule are for purposes of meeting the reasonableness condition of ERISA section 408(b)(2); if the conditions of an exemption are not satisfied, responsible plan fiduciaries and parties in interest may be subject to enforcement action and civil penalties under ERISA section 502.
Right to audit PBM disclosures
If you are a sponsor or fiduciary of a large self-insured group health plan, the final rule includes audit provisions that let you verify the accuracy of PBM and affiliated broker/consultant compensation disclosures. Those audit provisions apply for plan years beginning on or after July 1, 2027.
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Key Dates
Department and Agencies
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