Labor Department Finalizes Rule Forcing PBM Fee Disclosures

The U.S. Department of Labor finalized a rule Wednesday requiring pharmacy benefit managers to disclose their fees, rebates, and compensation arrangements to large employers that self-insure their workers' health coverage — a mandate projected to cut prescription drug costs by as much as $22 billion over 10 years.

PBMs serve as intermediaries in the prescription drug supply chain for employer-sponsored health plans covering roughly 90 million Americans. Under the new rule, PBMs must for the first time reveal rebates collected from drug manufacturers, spread pricing — instances where the plan pays more for a drug than the pharmacy is reimbursed — and payments recouped from pharmacies when drugs are dispensed to plan participants.

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The rule implements transparency provisions included in the bipartisan Consolidated Appropriations Act, 2026, and fulfills a directive in President Trump's executive order aimed at making the prescription drug market more competitive. Labor Secretary Keith Sonderling characterized the rule as ending years of PBMs "operating in the shadows" while workers bore the cost of hidden fees.

Employers can use the newly required disclosures to assess whether PBM compensation is reasonable under the Employee Retirement Income Security Act and to negotiate contracts more aggressively. Plan fiduciaries are also granted the right to audit PBM disclosures, and the rule provides additional protections for employers if a PBM fails to meet its obligations.

CMS Administrator Dr. Mehmet Oz framed the regulation as part of a broader cross-agency effort to introduce market competition into health care, asserting that greater transparency would put downward pressure on costs for workers and families. Continue reading at DOL News Releases and Briefs.