pharmacy-benefit-managers

1. October 31, 2026News4 receipts2 min

   Labor's final PBM rule requires fee disclosure and audit access for covered large self-insured health plans

   A Labor Department final rule scheduled for Federal Register publication November 2 requires covered pharmacy-benefit service providers to disclose compensation to fiduciaries of large self-insured ERISA health plans. It also provides audit access and machine-readable compensation information on request. The requirements apply to plan years beginning on or after July 1, 2027; the rule does not promise lower individual prescription prices.

   Also filed underhealth-plansprescription-drugsfee-disclosureerisafederal-register

2. October 19, 2026News3 receipts5 min

   CMS proposes a Medicare rule that would eliminate some generic-drug copays, require Medicare Advantage provider-directory accuracy, and limit PBM pay, starting in 2028

   The Centers for Medicare & Medicaid Services has proposed a rule, scheduled to be published in the Federal Register on October 20, 2026, to carry out three sections of the Consolidated Appropriations Act, 2026. It would zero out the generic-drug copay for about 6 million low-income enrollees, make Medicare Advantage plans verify their provider directories and charge only the lower cost sharing when an enrollee relied on a wrong listing, and limit pharmacy benefit manager pay to flat service fees, mostly from 2028. Comments are due at 5 p.m. Eastern Standard Time on December 15, 2026.

   Also filed undermedicaremedicare-advantageprescription-drugsfederal-register

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