Pharmacy benefit managers will have to show large self-insured plans what they earn

If your organization pays its employees' health claims itself, someone on your side signs the contract with a pharmacy benefit manager. On 2 November 2026 the Department of Labor's Employee Benefits Security Administration published a final rule that changes what that person should get to see before signing (91 FR 69092, amending 29 CFR part 2550).

The rule is titled "Improving Transparency Into Pharmacy Benefit Manager Fee Disclosure." In the Department's words, it will "require providers of pharmacy benefit management services and affiliated providers of brokerage and consulting services to disclose information about their compensation to fiduciaries of large, self-insured group health plans subject to the Employee Retirement Income Security Act (ERISA)."

The Department's reason is short. "Pharmacy spending is a major driver of overall healthcare costs for employers and is growing faster than medical and surgical spending."

The dates

The dates section reads: "This regulation is effective January 4, 2027. This regulation is applicable to plan years beginning on or after July 1, 2027."

For a plan that runs on the calendar year, the first plan year the rule reaches is the one starting on 1 January 2028. A plan whose year starts on 1 July gets there six months sooner, in July 2027. Either way, the contracts that will cover those plan years are probably being negotiated now or soon.

Who it covers

The rule works through ERISA section 408(b)(2). That is the exemption a plan relies on when it pays a service provider, and it depends on the arrangement being reasonable. The new disclosures are meant to give the fiduciary what it needs to judge that, for pharmacy benefit managers and for the brokers and consultants affiliated with them.

The plans in scope are self-insured. The Department borrowed its size test from ERISA section 726, a reporting provision Congress added in the Consolidated Appropriations Act, 2026. That section reaches self-insured "specified large employers" (generally with at least 100 employees) and "specified large plans" (generally with at least 100 participants).

Fully insured plans are a different case. Under section 726, "Employers with fully insured plans that meet these size specifications can opt in to receive the report." The final rule itself is written for self-insured plans, so an employer that buys insurance should check with its carrier and its adviser before assuming either way.

What gets disclosed, and how often

The provider has to make "advance disclosure of compensation they reasonably expect to receive." After that, "The final rule provides for disclosures on a semiannual basis or, at the request of the group health plan, quarterly."

The disclosures cover spread compensation, among other things, and the Department says the rule defines spread compensation in line with section 726. It also adopted section 726's reporting period and drug pricing terms, so a plan should not have to reconcile two different vocabularies.

How it fits with the 2026 statute

The 2026 statute makes the timeline busier. The Consolidated Appropriations Act, 2026 made its own PBM changes to ERISA. "ERISA section 726 is applicable to plan years beginning on or after August 3, 2028." A separate new requirement in section 408(b)(2)(C) has PBMs pass through "100% of rebates, fees, alternative discounts, and other remuneration" tied to the plan's drug use, and it takes effect for plan years beginning on or after the same date.

The Department did not wait for 2028. It kept its own July 2027 date, and it decided to keep most of the rule's disclosures even once the pass-through requirement starts. That leaves a stretch of roughly a year, depending on when your plan year begins, when the regulation applies and section 726 does not yet.

What it could mean

We think the rule matters most at renewal, while the PBM contract is still open. If your organization self-insures and has 100 or more employees, the plan years that start from July 2027 onward are the ones to have in mind at renewal. Ask your PBM now how it plans to handle the advance disclosure. The first semiannual report is a late place to find out.

Our guess is that the affiliated broker or consultant is the part people miss. A benefits adviser owned by, or paid through, a PBM's corporate family is pulled in too. If your adviser is recommending the PBM, it may be worth asking where the adviser's own pay comes from before the rule makes them say so.

For banks and credit unions there's a second angle. A PBM is a vendor like any other, and its contract usually sits with HR rather than with the people who run vendor management. The disclosures are a reason to bring it into the same review.

Smaller employers on fully insured plans can probably set this one aside for now. The bigger change for them may be the 2028 pass-through rule, and that one is still a year and a half away.