Association Weighs in on DOL S Proposed PBM Transparency Rule

The Association submitted a comment letter to the U.S. Department of Labor’s Employee Benefits Security Administration in response to the proposed rule “Improving Pharmacy Benefit Manager Compensation Transparency.” The proposal, which is supported by Association members, would require PBMs—and affiliated brokerage and consulting service providers—to disclose compensation information to fiduciaries of self-insured, ERISA-governed group health plans.

Why this matters: Employer-sponsored coverage remains the largest source of health insurance in the U.S., covering nearly 177 million people. However, costs continue to climb—rising nearly 9% per employee on average for the same level of coverage, with employers seeing the largest increases in 15 years (per Mercer survey data).

• Pharmacy spending now represents roughly 20–25% of total health care costs and is expected to grow, driven largely by specialty drugs (less than 2% of prescriptions but more than half of drug spending).

• Against this backdrop, plan fiduciaries face a core challenge: PBM compensation can be difficult to see and compare, even though fiduciaries must ensure compensation is reasonable and arrangements comply with ERISA’s prohibited transaction rules.

What the proposed rule would do: The proposal is designed to bring visibility to forms of PBM remuneration that have historically been opaque, including manufacturer rebates and fees, spread pricing, pharmacy claw-backs, and payments to affiliates, agents, and subcontractors. Done right, these disclosures can help plan sponsors:

• Compare PBM offerings

• Identify less visible compensation arrangements and potential conflicts of interest

• Strengthen fiduciary oversight and improve contracting outcomes

Key points from the Association’s recommendations: Our letter strongly supports the goal of meaningful transparency and encourages DOL to finalize a workable framework that promotes fiduciary compliance while avoiding unnecessary administrative burden. Among our recommendations:

• Finalize the rule without delay, while harmonizing where possible with other federal transparency requirements (including the 2026 Consolidated Appropriations Act provisions).

• Standardize definitions and reporting formats so disclosures are actually comparable and actionable for employers.

• Clarify that PBMs and covered service providers are responsible for the accuracy and completeness of compensation disclosures (while fiduciaries retain responsibility to assess reasonableness under ERISA).

Read our full comment letter here.

Looking ahead: DOL is expected to finalize the rule this fall. If finalized as proposed, the regulations would become effective 60 days after publication and would apply to plan years beginning on or after July 1, 2026. The Association will continue monitoring developments and share updates as DOL moves toward a final rule.