Pharmacy benefit managers must disclose fees under new federal rule

What PBMs now have to hand over

PBMs must report the rebates they negotiate with drugmakers and any spread payments, the money a PBM keeps when a plan pays more for a drug than the PBM pays the pharmacy. They owe that information when a contract is negotiated or renewed and again every six months, and employers get an annual audit right. PBMs that don’t comply face financial penalties and could see their contracts voided, Healthcare Dive reported.

Just under half of large employers say they get enough insight into what drugmakers pay their health plan or PBM, according to KFF’s 2026 Employer Health Benefits Survey. Meanwhile, WTW projects drug costs will climb 11.5 percent in 2026, up from 9 percent last year.

HRD America reported in October that pharmacy benefit rebates are rising while employer drug costs keep climbing. A bigger rebate guarantee, that report found, doesn’t mean a self-funded employer is paying less for drugs.

Employers were already pulling back from the big PBMs

The rule lands as self-funded employers move business away from the three largest pharmacy benefit managers ahead of federal rebate pass-through requirements that apply to plan years beginning on or after Aug. 3, 2028, HRD America found.

Daniel Aronowitz, who heads EBSA at the Department of Labor in Washington, D.C., said the department is “opening the black box and keeping it open forever,” the Plan Sponsor Council of America reported. He expects fees to fall over time, the way they did after 401(k) service providers had to disclose theirs.