The final PBM fee disclosure rule states that it "does not prohibit spread pricing or require that PBMs pass on 100 percent of rebates" (91 FR 69160). It creates a right for covered plans to audit their covered service providers at least once a year; the plan pays the auditor and the provider bears data costs (91 FR 69136). Fully insured plans are excluded and "reserved ... for future action" (91 FR 69184).
On cost and benefit, the department cites a Congressional Budget Office estimate that S.1339 in the 118th Congress could lower employer premiums by "less than 0.1 percent in the first year," and a paper commissioned by a PBM trade association claiming disclosure could cost up to $26.9 billion (91 FR 69159-60). The trade-association figure comes from an advocacy source. The rule's own dollar cost tables are images BTP has not read.
BTP argues that until the 2026 spending law's pass-through applies to plan years beginning on or after August 3, 2028, covered plans gain visibility into PBM pay, not refunds of it.