Labor Department benefits chief Daniel Aronowitz signed a final rule on October 28, 2026 requiring pharmacy benefit managers to disclose their direct and indirect pay, including rebates, spread compensation and fees, to fiduciaries of large self-insured employer health plans. It was filed for public inspection October 30 and publishes November 2 as FR Doc 2026-22306. It covers 131,102 plans. The January 30 proposal covered 1,150,583.
The proposal's table (91 FR 4383, section 7.1) counted 1,031,098 small level-funded plans, 104,123 plans with 100 to 999 participants and 15,362 with 1,000 or more. The final rule's table (91 FR 69155, section 6.1) counts 113,226 and 17,876. BTP's math: 131,102 is 11.4 percent of 1,150,583, an 88.6 percent drop, or 1,019,481 fewer plans. The two tables use different data years (2023 and 2024 MEPS-IC; 2021 and 2022 County Business Patterns), and large-plan counts grew from 119,485 to 131,102, so the comparison is cross-vintage. The department estimates 953,420 small level-funded plans are left out (91 FR 69184, section 12.2).
The department says it matched the 100-employee-or-participant line in new ERISA section 726 from the Consolidated Appropriations Act of 2026, that small plans lack staff to use detailed disclosures, and that they still receive generalized disclosures under ERISA 408(b)(2)(B), in force since February 3, 2026, and a summary document under section 726. Some commenters urged withdrawal of the whole rule as duplicative. BTP reviewed no lobbying records and makes no claim that industry influence caused the narrowing.
BTP argues the plans least able to challenge a middleman lost the detailed view. Workers pay through premiums, deductibles and coinsurance tied to list prices; the rule says list-price increases "can be detrimental to participants." Covered plans gain a yearly audit right, with the plan paying the auditor and the PBM bearing data costs (91 FR 69136), but the rule "does not prohibit spread pricing or require that PBMs pass on 100 percent of rebates" (91 FR 69160). Fully insured plans are "reserved ... for future action" (91 FR 69184).
Dates: effective January 4, 2027; applies to plan years beginning on or after July 1, 2027, which for a calendar-year plan means January 1, 2028; the 2026 law's 100 percent rebate pass-through and drug-spending reports apply to plan years beginning on or after August 3, 2028. The rule was ordered by Executive Order 14273, signed April 15, 2025. A comment-period extension, FR Doc 2026-04084, published March 2, 2026.