The U.S. Department of Labor’s (DOL) new Pharmacy Benefit Manager (PBM) Transparency and Disclosure Rule seeks to increase transparency in PBM financial arrangements and strengthen oversight of prescription drug spending. The rule would require PBMs to disclose detailed information about their compensation, including manufacturer rebates, spread pricing, and pharmacy clawbacks, to fiduciaries of covered self-insured employer health plans. By providing greater visibility into PBM compensation and expanding audit rights, the proposed rule aims to help plan sponsors identify potential conflicts of interest, evaluate PBM relationships, and better manage prescription drug costs.
In a recent Drug Store News article, Matthew Modafferi discussed the rule’s potential impact and the challenges that remain.
“The rule is a positive step toward pharmacy benefit transparency. Hidden fees and compensation are obstacles that prevent plan sponsors from conducting meaningful PBM audits.”
Matthew also raised questions about whether PBMs will agree to a fiduciary standard of care and whether the rule will require disclosure of compensation received by affiliated pharmacies and group purchasing organizations. Ultimately, its effectiveness will depend on whether it provides plan sponsors with the transparency and accountability needed to meaningfully evaluate their PBM relationships.
