Pharmacy benefit managers continue to draw scrutiny in Washington, and two recent federal actions signal that greater transparency and oversight may be on the horizon. One is a newly enacted funding law that includes PBM reforms, and the other is a proposed Department of Labor rule that could significantly expand disclosure obligations under ERISA. Here’s what we know now:
Congress passes funding bill with PBM reforms and transparency requirements
A federal funding package signed by President Trump on February 4 includes reforms prohibiting PBMs from tying compensation to drug manufacturers’ list prices in Medicare Part D, along with new transparency requirements. While focused on Medicare, the changes reflect broader bipartisan concern about PBM-driven drug costs and could signal future standards for self-funded plans.
Department of Labor proposes sweeping PBM compensation disclosures for self-funded plans
The U.S. Department of Labor has proposed regulations requiring PBMs to disclose detailed compensation information to fiduciaries of ERISA-covered self-funded health plans. The goal is to help plan sponsors assess whether PBM contracts and fees are reasonable, including indirect compensation such as spread pricing. If finalized, the rule could take effect as early as July 1. Comments are due by March 31.
The MedBen Compliance team is reviewing both the newly enacted legislation and the DOL’s proposed rule to assess their potential implications for self-funded organizations. We will continue to monitor developments closely and keep you informed as more detail emerges regarding compliance obligations, timing, and impact.