Within a one-week period, there were two actions at the federal level to increase pharmacy benefits manager (PBM) transparency. The Consolidated Appropriations Act of 2026 (CAA 2026) and Department of Labor...
Key Takeaways:
Within a one-week period, there were two actions at the federal level to increase pharmacy benefits manager (PBM) transparency. The Consolidated Appropriations Act of 2026 (CAA 2026) and Department of Labor (DOL) proposed regulations on PBM compensation disclosures (DOL Proposed Rules) are complementary but differ in significant respects. CAA 2026 is broader in scope (applying to all group health plans, including fully insured arrangements), but has a later effective date and creates distinctions based on employer/plan size. In contrast, the DOL Proposed Rules only cover compensation disclosures and apply only to self-funded ERISA plans but would take effect much sooner and apply uniformly regardless of employer size.
From a compliance perspective, CAA 2026's express civil penalties ($10,000 per day for non-disclosure; $100,000 per item for false information) provide a more direct enforcement mechanism, whereas the DOL Proposed Rules leverage the ERISA prohibited transaction framework, which can result in excise taxes and equitable remedies but lacks the same bright-line penalty structure.
Notably, CAA 2026 mandates 100% rebate pass-through for plans subject to ERISA, while the DOL Proposed Rules require only disclosure of rebates retained versus...
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