DOL to Unveil PBM Transparency Rule on Thursday

The Department of Labor is expected to release tomorrow the final version of Improving Transparency Into Pharmacy Benefit Manager Fee Disclosure, a rule that, under the Employee Retirement Income Security Act, would require pharmacy benefit managers to disclose all direct and indirect compensation to plan fiduciaries, 

The rule aligns with the Consolidated Appropriations Act of 2026’s mandatory rebate pass-through and reporting requirements. The law requires PBMs to pass through 100% of any rebates, fees, alternative discounts and other remuneration received from drug manufacturers and related entities to the ERISA plan.

During a media briefing on Wednesday, Representative Ryan Mackenzie, R-Pennsylvania, and healthcare benefits experts lauded the DOL’s pending rule, stressing it was vital, alongside bipartisan congressional action, to establishing “net effective cost” as the standard for prescription drug pricing across the healthcare market.

Congressional Action

Mackenzie and co-sponsors, including Representative Lucy McBath, D-Georgia, in September introduced the Net Effective Cost Transparency and Prescription Drug Affordability Act of 2026, a bill designed to increase transparency and competition in the PBM market and help lower prescription drug costs. The bill would require greater transparency into what prescription drugs cost after rebates, discounts, fees and other price concessions are considered. Representatives Jake Auchincloss, D-Massachusetts; Rick Allen, R-Georgia; and Carol Miller, R-West Virginia, co-sponsored the legislation.

During the Wednesday briefing, Mackenzie said the net effective bill, along with the PBM Fiduciary Accountability, Integrity and Reform Act—a bill he introduced in the House in December to establish fiduciary responsibilities for PBMs under ERISA—complement the forthcoming DOL rule. Both pieces of legislation, he said, would require that PBMs act as fiduciaries and in the “best interest of employers and their health plans.”

“To make informed decisions, employers need a clearer picture of what they’re actually paying for prescription drugs,” Mackenzie said. “That means accounting for rebates, discounts, fees and other financial arrangements that make it difficult to determine the true cost of their health benefit plans.”

Without that information, Mackenzie said, employers cannot accurately compare PBM proposals, evaluate their options and determine which provider offers the best value for their employees.

“We need a more transparent system to give employers a clear, consistent set of information so that they can compare their costs, make informed decisions and get the best value for their healthcare dollars,” Mackenzie said. “The DOL’s rule is another important step toward that goal.”

Additional Support from Industry Speakers

Christina Strogis, director of health policy and federal affairs at the ERISA Industry Committee, also supported the proposed rule, highlighting at the briefing the sense of freedom she said she feels employers will gain from it.

“For years, employers have been operating with one hand tied behind their back,” Strogis said. “Without clear, standardized disclosures from PBMs and their affiliated entities, plan sponsors struggle to determine where their money goes, and whether their PBM is delivering the value [it] promised.”

Strogis said that “access to complete, unmasked data” that the new rule promises could disrupt the trend, supporting “better decisions, stronger vendor accountability and a PBM strategy focused on protecting employees and families from inflated costs.”

Amy Wadstrom, president of Vivid Clear Rx and vice president of Midwest grocer Hy-Vee Inc., said healthcare was, and continues to be, one of her organization’s largest operational costs. Hy-Vee, Iowa’s largest private employer, provides health benefits to more than 75,000 employees and their beneficiaries.

“Affordability matters to every American now more than ever,” Wadstrom said. “Across the industry, pharmacy costs are rising at about 12% per year.”

Wadstrom said the DOL’s rule would “bring accountability to those who have chosen to operate with less transparency and bring into light questionable business practices that will no longer be shrouded in secrecy.”

Joe Shields, CEO of Transparency Rising, a nonprofit coalition of self-described “transparent” pharmacy benefit managers, partner companies and stakeholders that advocate for greater transparency and accountability in pharmacy benefits, said employers “still struggle to answer a basic question: What does each prescription actually cost after every rebate, discount, fee and spread is accounted for?”

“That’s what net effective cost is trying to get at,” Shields said. “It should anchor every PBM bid, contract negotiation, and evaluation of performance.”

Shields said he anticipates that almost all of what was included in the DOL’s proposed rule will make it into the final rule. He said that the rollout is expected to include more information about the scales of rebate economics and affiliate economics that will be involved.

Greg Baker, CEO of AffirmedRx, a PBM serving self-funded employers, said compared with transparency in other markets, the PBM industry is “opaque.”

“Capitalism really only works when we have two things: true transparency and true competition,” Baker said. “And all of that concept falls apart in healthcare when large organizations stay in the shadows to maximize profit.”