Impacted: Self-insured ERISA group plans (excludes Medicare and Medicaid)

What you need to know

The Department of Labor’s (DOL) Employee Benefits Security Administration (EBSA) has proposed a rule requiring entities that contract with self-insured group health plans under ERISA, including PBMs, to disclose details about their fees and compensation. This aims to enhance transparency and help employers assess whether PBM and other service provider compensation is reasonable under ERISA requirements.  

The proposal excludes Medicare and Medicaid and does not bring immediate changes for plan sponsors.  

Public comments are open through March 31, 2026. 

Prime is actively monitoring developments and collaborating with Pharmaceutical Care Management Association (PCMA) to coordinate a thoughtful response as applicable. We will provide additional updates as more information becomes available. 

Overview

The proposed rule, developed by the DOL’s EBSA, focuses on increasing transparency into PBM compensation for ERISA plan fiduciaries. It builds on existing ERISA requirements governing service provider arrangements, including PBM services for self-insured employer plans.
Under the proposal, PBMs would be required to provide employers with clear disclosures describing how they are paid, including administrative fees, rebates and other forms of compensation, as well as certain payments involving affiliated entities and subcontractors.
Entities that provide advice, recommendations or referrals regarding the provision of PBM services also have disclosure and reporting obligations under the rule. These disclosures may include drug-level information, where applicable, to support employers in understanding PBM compensation and identify potential conflicts of interest as part of their existing fiduciary oversight. Disclosures would be provided prior to entering a contract and updated twice a year on an ongoing basis, allowing employers to maintain current visibility into PBM arrangements.
The proposal does not set limits on PBM compensation, mandate specific contract structures or change how pharmacy benefits must be designed. Instead, it emphasizes clarity and transparency, seeking to enable employers to more fully understand their PBM arrangements. 
The proposal applies specifically to self-insured employer health plans subject to ERISA and does not directly apply to fully insured plans, Medicare or Medicaid programs.  

Potential impacts and considerations

• If finalized, the rule would increase transparency expectations for PBM services supporting self-insured employer plans.
• For employer plan sponsors, the proposal would provide greater visibility into PBM compensation and reinforce existing fiduciary review and monitoring practices.
• For self-insured employers, the proposal may result in more standardized compensation disclosures but is not expected to require immediate changes to existing benefit designs or contracts.
• For the broader market, while limited in scope to ERISA plans, the proposal reflects ongoing federal interest in drug pricing transparency and accountability, which could influence future policy discussions.

Commenting process 

The DOL is accepting public comments on the proposed PBM fee disclosure rule (RIN 1210-AB37) until March 31, 2026. Employers, PBMs and other stakeholders may submit comments on any aspect of the proposal. All submissions will become public record.

Prime's positions and next steps

Prime shares the broader goal of advancing transparency across the pharmacy benefits industry. While we are reviewing the specifics of the proposed rule, our focus remains on giving clients meaningful visibility into how their benefit dollars are used and how Prime’s aligned, pass‑through model works on their behalf. We remain committed to helping clients and stakeholders understand the underlying cost drivers, incentives and safeguards built into Prime’s model so they can make informed, confident decisions.

As we continue to review the proposed rule, Prime will also engage with PCMA on their approach to submitting comments and assess our specific approach to the comment period.

Prime is also actively engaging in dialogue with key stakeholders to better understand potential impacts and prepare informed feedback. The team is dedicated to remaining proactive and responsive throughout the regulatory process. We will provide updates as we learn more.

Questions

Please reach out to your Prime client account team representative.