Impacted: Self-insured ERISA group plans (excludes Medicare and Medicaid), health plan clients

What you need to know

As a follow up to our previous communication in February 2026, Prime submitted a comment letter in response to the U.S. Department of Labor’s (DOL) Employee Benefits Security Administration (EBSA) proposed rule requiring entities that contract with self-insured group health plans under ERISA — including pharmacy benefit managers (PBMs) — to disclose details about their fees and compensation. The full text of our comment letter can be accessed here.

The proposed rule was introduced in January 2026 and is intended to enhance transparency and help employers assess whether PBM and other service provider compensation is reasonable under ERISA requirements. Prime supports this goal and remains focused on providing our clients with meaningful visibility into their pharmacy benefit arrangements. 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 decisions. In keeping with that commitment, we are sharing our filed comments and a summary of our position for your awareness.   

Note: Comments were originally due by March 31, 2026, and the deadline was subsequently extended to April 15, 2026. There is no required client action at this time.

Background

The proposed rule focuses on increasing transparency into PBM compensation for ERISA plan fiduciaries. 

Under the proposal, PBMs would be required to provide plan fiduciaries with disclosures on how they are compensated, including administrative fees, rebates and other forms of remuneration, as well as certain payments involving affiliated entities and subcontractors. These disclosures are intended to support fiduciaries in fulfilling their oversight responsibilities. 

The proposal applies to self-insured ERISA-covered plans and does not extend to insured ERISA plans, or Medicare and Medicaid programs. It does not impose direct limits on PBM compensation or require changes to benefit design. Instead, it emphasizes transparency into existing arrangements. A complete summary of potential impacts and considerations can be referenced in our initial communication. 

Prime's position

We actively engaged with the Pharmaceutical Care Management Association (PCMA) throughout this process and support their comments, which urged the department to reconsider the proposal in light of the Consolidated Appropriations Act, 2026 (CAA, 2026) framework, which establishes comprehensive PBM transparency requirements. Prime shares the department’s overall goal of advancing a transparency framework that is both effective and operationally feasible for plan fiduciaries. At the same time, we believe the proposed rule introduces significant operational complexity without commensurate improvement in meaningful transparency for plan fiduciaries.

Summary of key themes from our comments include: 

• Alignment with CAA, 2026: The proposal should be harmonized with recently enacted statutory requirements to avoid duplicative and inconsistent reporting obligations.
• Focus on meaningful, actionable information: Disclosures should reflect how PBM arrangements operate in practice and support plan fiduciaries in evaluating service provider relationships.
• Operational feasibility: Certain proposed requirements, including drug-level reporting and pre-contract disclosure, may introduce significant complexity without improving meaningful transparency.
• Appropriate guardrails: Audit and data use provisions should include clear limitations to protect sensitive information and ensure alignment with existing statutory frameworks.

Next steps

The proposed rule is expected to be finalized in late 2026 but could come as early as mid-summer 2026. We will continue to monitor for developments and keep you updated.

Questions

Please reach out to your Prime account team representative.