Proposed DOL Regulations for Pharmacy Benefit Managers

This document is a guide detailing the proposed regulations released by the Department of Labor’s Employee Benefits Security Administration concerning Pharmacy Benefit Managers (PBMs). The proposed rules aim to enhance transparency for self-insured plan sponsors and fiduciaries regarding the compensation received by PBMs and their affiliates. It outlines comprehensive federal requirements for PBM service providers to disclose all forms of direct and indirect compensation, pricing methodologies, and formulary-related incentives. The guide explains that these rules will reshape PBM contracting and oversight starting from July 1, 2026. Key components include initial compensation disclosures, biannual reports on actual earnings, and audit rights for fiduciaries. The document emphasizes the importance of these disclosures for fiduciaries to evaluate the reasonableness of PBM compensation and avoid prohibited transactions under ERISA. Additionally, it discusses the potential penalties for non-compliance and the administrative class exemption proposed for fiduciaries acting in good faith.