The Department of Labor finalized its pharmacy benefit manager disclosure rule on October 29, completing a proposal first made in January. Under the rule, PBMs serving large self insured group health plans must disclose the compensation they receive, direct and indirect, including rebates negotiated with drugmakers, spread payments kept when a plan pays more for a drug than the PBM reimburses the pharmacy, copay clawbacks, and financial relationships with brokers and consultants that could create conflicts of interest. Disclosures are required before a contract is signed or renewed, with actual compensation reported every six months, and employers may audit the disclosures once a year.
The scale is broad. Federal officials estimate the rule will apply to more than 70 PBMs and 130,000 employers, covering plans with at least 100 participants or sponsors with at least 100 workers, and project savings of more than $800 million a year, or up to $22 billion over ten years, through lower drug costs. Non compliance carries financial penalties and possible invalidation of the PBM’s contract. Secretary of Labor Keith Sonderling said the rule is a win for every American worker who has paid too much at the pharmacy counter, and Assistant Secretary Daniel Aronowitz told PBMs at the announcement that the jig is up.
The structure overlaps deliberately with statute. The Consolidated Appropriations Act of 2026 already requires detailed retrospective disclosure of drug spending and utilization, and the Department aligned definitions and timelines with that law while arguing the two regimes complement each other: the Act reports what was spent, while the Labor rule forces disclosure up front, before a plan chooses or renews a PBM, so fiduciaries can compare offers. Employer groups welcomed exactly that distinction, with the ERISA Industry Committee saying employers will finally be able to check the numbers and hold vendors to their contracts.
Opposition is legal as much as commercial. The Pharmaceutical Care Management Association called the rule duplicative government overreach and a solution in search of a problem, and PBM commenters on the draft argued the Department lacks authority to compel the disclosures, a challenge STAT reports the rules will now face. The three largest PBMs, Express Scripts, Caremark and Optum Rx, jointly handle about 80 percent of United States prescriptions, which is why an employer side transparency rule, rather than another drugmaker facing measure, is the structurally significant move: it changes who can see the money, starting with plan years from July 1, 2027.