What New PBM Transparency Rules Mean for Plan Sponsors and Advisors

The rules that govern how pharmacy benefits managers (PBMs) operate are changing quickly, and plan sponsors and advisors are being asked to keep pace in an environment that is becoming more complex by the month. What once looked like a market trend is now taking shape as a compliance and fiduciary issue. Federal legislation, regulatory proposals, and enforcement actions are all pointing in the same direction: more disclosure, more accountability, and more scrutiny of how pharmacy benefit arrangements are structured and managed.
For employers, that means pharmacy benefits can no longer be treated as a largely hands-off vendor relationship. For advisors, it means clients will need help understanding not just what is changing, but how those changes affect governance, contracting, and ongoing oversight. Here’s what’s happening, and what it means for your book of business.

Why the Industry is Moving Toward Transparency

For years, plan sponsors had limited visibility into PBM revenue models. Rebate retention, spread pricing, and encouraging use of PBM-owned pharmacies often were not fully known to the employers ultimately paying the bill. That level of opacity has become increasingly difficult to defend. Three federal forces are driving the shift:

1. The Consolidated Appropriations Act of 2026: Signed February 3, 2026, the Consolidated Appropriations Act of 2026 (CAA) establishes significant new compliance obligations for group health plans and sets a definitive timeline for the pharmacy benefits industry’s transition to a transparent rebate model. The law requires 100% rebate pass-through beginning with plan years starting on or after August 3, 2028 (January 1, 2029, for calendar-year plans), preserves an exception for transparent, fair-market-value bona fide service fees, and mandates detailed semi-annual PBM reporting and expanded audit rights for plan sponsors.

2. The DOL proposed rule: In January 2026, the Department of Labor (DOL) proposed a rule requiring PBM compensation disclosures specifically for plans covered by the federal Employee Retirement Income Security Act of 1974 (ERISA). As of today, it remains a proposal and could be superseded by what the CAA already requires. If finalized, it would require advance and semi-annual disclosures, including drug-level information on items such as spread pricing, manufacturer payments, formulary placement incentives, and related audit rights.

3. FTC enforcement: In February 2026, the Federal Trade Commission (FTC) settled with Express Scripts, requiring a new standard offering designed to reduce reliance on list price -driven incentives. Key provisions include basing member cost-sharing on net cost rather than list price, passing rebates through at the point of sale, delinking compensation from list price, and moving toward more transparent pharmacy reimbursement. CVS Caremark later reached a similar settlement, and Optum Rx remains under FTC pressure, suggesting additional action may follow.

In addition to these federal implications, there are also a variety of state-based PBM regulations that have taken effect already or may do so in the coming months and years. Employers under additional local guidelines have further requirements to consider, and multi-state employers may be juggling even more.

Increased disclosure is only part of this story. The larger shift is that employers are increasingly expected to do more than purchase and periodically review a pharmacy benefits arrangement. They are being pushed toward a more active fiduciary role, with greater responsibility to review compensation, assess performance, and act on the information they receive.

From Awareness to Action

The immediate priority is helping your clients prepare for what’s on the horizon. Guide them to review PBM contracts now, confirm audit rights, understand what disclosures they will be entitled to receive, and establish a process for evaluating PBM performance and compensation once that information becomes available. This is where an advisor’s expertise turns a looming compliance obligation into a manageable plan.

That work will also require stronger governance, and it’s also an area where advisor guidance carries real weight. In this environment, fiduciary responsibility increasingly means having documented decision-making, a repeatable review process, and a clear rationale for determining whether PBM arrangements are reasonable and effective. Advisors can help their clients build those structures before regulators, or plan participants, start asking questions.

Audit rights, in particular, matter only if clients are prepared to use them. The same is true of compensation disclosures. Greater visibility into pricing, fees, and manufacturer payments will have limited value unless plan sponsors also have a framework for interpreting that information and deciding when follow-up, renegotiation, or corrective action is warranted. Advisors can supply that framework, translating raw data into defensible strategies.

Most of the key requirements phase occurs over the next few years, but the operational work starts well before the deadlines. Whether employers build that capability internally or rely on a TPA or advisor, the infrastructure needs to be in place ahead of the effective dates — not after them.

Where Advisors Can Lead Now

Transparency is moving from a competitive differentiator to a baseline expectation. Advisors who build the muscle now will be the ones clients lean on when deadlines hit. Here’s where to focus:

  • New compliance workload, on a real clock. Most CAA provisions phase in around 2028 and 2029. But the law effectively forces action earlier, since PBM contract terms will need to be reviewed and renegotiated before renewal cycles lock in outdated provisions.
  • You become an interpreter, not just a broker. Plan fiduciaries now need governance structures, a disclosure review strategy, and a process for evaluating downstream effects on drug costs. Most employer clients can’t do that alone, which raises both the value and the liability exposure of your role.
  • Rebate pass-through isn’t a free win. As PBMs lose rebate-based revenue, expect them to raise flat per-member-per-month (PMPM) admin fees or add performance-based fees instead. Help your clients evaluate total cost, not just the optics of one compensation change.
  • Audit rights become a real lever. New annual audit rights, recurring reporting, and penalties for non-disclosure give advisors and plan sponsors access to information they have historically lacked. The advantage will go to those who can interpret that data, identify conflicts or inefficiencies, and help clients make defensible decisions.

Advisor Guidance Matters More Than Ever

The future is clear: pharmacy benefits are moving into a more transparent, more regulated, and more actively governed era. For plan sponsors, that raises the bar on oversight. For advisors, it raises the bar on guidance. The organizations that start preparing now will be in a stronger position to respond to new disclosure requirements, renegotiate contracts from a position of knowledge, and help ensure pharmacy benefit decisions hold up under greater scrutiny. In the next phase of this market, transparency will matter — but the ability to evaluate and act on that transparency will matter even more.