According to the Department of Labor: rebates and other manufacturer payments, compensation when the plan’s price exceeds the pharmacy’s reimbursement, and payments recouped from pharmacies.
The Department of Labor lists three new disclosures: rebates and other payments from drug manufacturers, compensation earned when the plan’s price for a drug exceeds the amount reimbursed to the pharmacy, and payments recouped from pharmacies for drugs dispensed to participants.
The law-firm summary adds that disclosures are reported before an arrangement is entered, extended or renewed, semiannually, and quarterly on request.
The Department of Labor’s release describes disclosures about rebates, spread pricing, recoupments, and audit rights. In plain terms, they help a plan see what the pharmacy benefit manager is paid and what it keeps, which was often hard to see before.
A plan fiduciary can use that information to ask specific questions: how much rebate money is passed back, whether the plan pays more than the pharmacy is paid, and what the plan can audit. We help translate the disclosures into a short list of questions for your PBM contract review.
What a fiduciary should be able to answer about a pharmacy contract.
How ERISA section 408(b)(2) applies to fees your plan pays.
Share the renewal and plan documents and we will tell you what to test.
It is reported to apply to self-insured plans of larger employers, with a threshold of 100 employees or participants, and not to the detailed requirements for fully insured plans.
The applicability date is reported as plan years beginning on or after July 1, 2027.
The Department says the rule lets fiduciaries audit the accuracy of PBM disclosures.
Details are from the Department of Labor’s announcement, the Federal Register entry and a law-firm summary, as of publication. Check the rule text for dates and thresholds.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.