New Mandates Force PBMs to Disclose Business Dealings
The Trump administration is intensifying efforts to crack down on companies that manage drug benefits for most Americans.
Why it matters:
Pharmacy Benefit Managers (PBMs) are again under scrutiny from the administration over allegations of opaque business practices and their potential manipulation of markets at patients' expense.
Driving the news:
The Department of Labor finalized a rule on Thursday requiring PBMs to disclose semiannually their earnings from negotiating drug prices on behalf of employer health plans, or at the time of agreement renewal or extension. Companies like CVS Caremark, Express Scripts, and Optum Rx will need to detail:
- Payments from drug manufacturers
- Instances of "spread pricing" (when a health plan pays more for a drug than the pharmacy's reimbursement)
- Situations where the drug's total cost is less than a patient's copayment
Health plans can audit PBMs at least annually, and PBMs must provide an explanation if their earnings exceed 5% of their estimated amount.
The rule:
This rule stems from President Trump's executive order on lowering drug prices and follows FTC settlements with leading PBMs over alleged anticompetitive practices.
What they're saying:
“This is a win for every American worker who has ever paid too much at the pharmacy counter,” said Labor Secretary Keith Sonderling. “For years, PBMs have operated in the shadows, pocketing hidden fees while workers and employers were left in the dark.”
Officials highlight recent projections showing steep health cost increases, with employees' share of family coverage up 9% from 2025.
However, the Pharmaceutical Care Management Association (PCMA), a PBM trade group, disagrees: “It is a solution in search of a problem,” said their CEO, David Marin, suggesting it could lead to higher patient costs and reduced competition.
Between the lines:
The rule takes effect in July, applying to self-insured group plans with over 100 participants. It comes into effect a year before PBM changes mandated by Congress.
Supporters, like Transparency Rising (a PBM trade group), believe the rule has teeth as disclosure is tied to ERISA rules, and health plan fiduciaries must report PBMs failing to provide the required information.
However, the rule covers fewer plans than initially planned, and there are no direct restrictions on PBM pricing, spread pricing compensation, or the retention of manufacturer rebates.
What we're watching:
The rule may face legal challenges. Some PBMs are already restructuring in response to FTC settlements and in anticipation of mandated changes.