US Department of Labor finalizes pharmacy benefit manager transparency rule, delivering big win for American workers, families

The U.S. Department of Labor's Employee Benefits Security Administration finalized a rule requiring pharmacy benefit managers and their affiliated brokers and consultants to disclose fees and compensation to large employers' self-insured group health plans. The rule is issued under ERISA's statutory service provider prohibited transaction exemption and implements transparency reforms enacted in the Consolidated Appropriations Act, 2026. The final rule mandates PBM disclosure of three categories of compensation that were previously opaque to plan fiduciaries: rebates and other payments received from drug manufacturers; compensation received when the price paid by the plan for a prescription drug exceeds the amount reimbursed to the pharmacy; and payments recouped from pharmacies in connection with prescription drugs dispensed to plan participants. The rule also grants plan fiduciaries the right to audit the accuracy of PBM disclosures and provides additional fiduciary relief when a PBM fails to meet its disclosure obligations. The disclosures are designed to allow fiduciaries to assess the reasonableness of PBM compensation consistent with their duties under ERISA. The final rule is projected to lower prescription drug costs for health plans and participants by as much as $22 billion (undiscounted) over 10 years. PBMs serve as intermediaries in the prescription drug supply chain for employer-sponsored self-insured group health plans covering approximately 90 million Americans.