What the DOL Pharmacy Fee Rule Means for Michigan Self-Funded Employers.
Michigan’s insurance regulator does not review the rates of self-funded health plans. The Department of Labor’s new pharmacy benefit manager disclosure rule is the main federal oversight for them. This page reads the rule for a Michigan employer.
Who reviews a self-funded plan, and what changes
The Michigan Department of Insurance and Financial Services reviews and approves health insurance rates for individual and small group plans. It states that it does not have authority over the rates charged under a self-funded health care plan, which is regulated by the U.S. Department of Labor. For a Michigan employer with a self-funded plan, the Department of Labor is therefore the agency that sets the rules.
On October 29, 2026 the Department of Labor announced a final rule requiring pharmacy benefit managers, and their affiliated brokers and consultants, to disclose their fees and compensation to the fiduciaries of large employers’ self-insured group health plans. The new disclosures cover manufacturer rebates and other payments, compensation when the plan’s price exceeds the pharmacy’s reimbursement, and payments recouped from pharmacies. The rule also lets fiduciaries audit the accuracy of a PBM’s disclosures.
A law-firm summary published November 2, 2026 reports that the rule applies to self-insured plans of employers with at least 100 employees, and certain other self-insured plans with at least 100 participants, and reports an applicability date of plan years beginning on or after July 1, 2027. Many Michigan employers sit near that line, so the first step is to confirm whether the plan is self-insured, level-funded or fully insured. Check the rule text for the thresholds.
What a Michigan employer should do with this
Confirm how your plan is funded
Fully insured, level-funded and self-funded plans are treated differently. Know which you have.
Review your stop-loss and pharmacy together
How specific and aggregating deductibles interact with pharmacy claims.
Ask your PBM contract questions
The questions a fiduciary should be able to answer about a pharmacy contract.
Read the national rule summary
What the final rule requires, with the Department of Labor’s own description.
Know your BCBSM plan options
Plan families, networks and the questions we ask before a BCBSM renewal.
Send us your plan documents
Share your renewal and pharmacy contract and we will tell you what to ask for and when.
Questions Michigan employers are asking about the PBM rule
Does DIFS oversee my self-funded plan?
No. DIFS states it does not have authority over the rates charged under a self-funded health care plan. Those plans are regulated by the U.S. Department of Labor.
Does the rule apply to my level-funded plan?
It depends on how the plan is structured and its size. The rule is reported to apply to self-insured plans with at least 100 employees or participants, so many smaller level-funded plans may fall outside it. Send us the contract and we will look.
Does the rule apply if I am fully insured?
The law-firm summary reports that fully insured plans are excluded from the detailed requirements. Your carrier’s own filings and DIFS review still apply to the rate.
When should a Michigan employer act?
The reported applicability date is plan years beginning on or after July 1, 2027. A good-faith enforcement policy is reported to run until then, so asking your PBM questions this renewal is reasonable.
Is this legal advice?
No. We are benefits consultants, not attorneys. Read the final rule and talk to your counsel about your plan’s obligations.
Where these details come from.
Details are from the Michigan DIFS, the Department of Labor’s announcement and a law-firm summary, as of publication. Check the rule text for dates and thresholds.
Send us your renewal.
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.