Pharmacy benefit managers (PBMs) have two federal transparency developments to track: new reporting and rebate pass-through requirements enacted under the Consolidated Appropriations Act, 2026 (CAA 2026), and a separate Department of Labor (DOL) proposal addressing PBM compensation disclosures. The two measures overlap, but differ in what must be reported, which arrangements are covered and when the requirements apply.
PBMs need to understand what’s settled and what’s still pending to prioritize compliance work without building processes around requirements that are outdated or not yet finalized.
What Does CAA 2026 Require of PBMs?
Signed into law on February 3, 2026, CAA 2026 builds on earlier federal healthcare transparency requirements, expanding oversight of PBM financial practices through amendments to the Public Health Service Act and ERISA. Two provisions are especially significant.
PBM Financial Reporting Requirements
Section 6701 requires entities providing PBM services to submit financial reports to covered group health plans and health insurance issuers at least every six months, or quarterly when requested under the statute.
The required information varies by plan type and reporting category, including:
- Payments from plans to PBMs and from PBMs to pharmacies, including the difference between those amounts
- Rebates, discounts and other remuneration associated with prescription drugs
- Net drug spending, participant out-of-pocket costs and certain manufacturer assistance payments
- Specified formulary and affiliated-pharmacy information
The law establishes these reporting obligations, although standardized formats and certain implementation details still require federal rulemaking.
100% Pass-Through of PBM Rebates
Section 6702 establishes a requirement for PBMs to pass through 100% of qualifying rebates, fees and other remuneration to covered plans or issuers. The statute also requires quarterly remittance, generally within 90 days after the quarter ends, and establishes related audit protections.
The law still permits certain reasonable fees for bona fide PBM services, subject to statutory conditions.
Both provisions generally apply beginning with plan years starting at least 30 months after enactment. For calendar-year plans, that means January 1, 2029. However, applicability also depends on how each PBM’s business and contractual arrangements are structured, including when agreements are entered, renewed or extended.
What Would DOL’s Proposed PBM Fee Disclosure Rule Require?
DOL published its proposed PBM fee-disclosure rule on January 30, 2026, four days before CAA 2026 was enacted. DOL subsequently extended the comment period to allow stakeholders to address the new law. As of October 5, 2026, the proposal had not been finalized.
The proposal focuses on PBMs and certain brokers and consultants serving ERISA-covered self-insured group health plans and would establish more detailed requirements for disclosing compensation to plan fiduciaries.
The most consequential proposed provisions include:
- Upfront compensation disclosures: Before entering, renewing or extending covered contracts, service providers would disclose anticipated compensation, including direct fees, manufacturer payments, spread compensation, copay clawbacks, price-protection payments and certain formulary incentives.
- Semiannual actual-compensation disclosures: Providers would report actual compensation within 30 days after each six-month period. The proposal also calls for explanations when compensation materially exceeds initial estimates, generally by 5% or more.
- More specific audit and correction procedures: The proposal would establish additional requirements for verifying disclosures, accessing supporting records and addressing failures to disclose.
Existing ERISA service-provider rules already address certain compensation disclosures. DOL’s proposal would establish a more detailed, PBM-specific framework rather than introducing the entire concept of compensation transparency.
CAA 2026 vs. DOL’s PBM Proposal: Key Differences
CAA 2026 establishes new PBM reporting and rebate requirements, while DOL’s proposed rule addresses more detailed compensation disclosures to plan fiduciaries. The two overlap, but differ in scope and implementation.
| Issue | CAA 2026 – Enacted Law | DOL PBM Fee-Disclosure – Proposed Rule |
| Financial reporting | Requires periodic reporting of drug spending, pharmacy payments, rebates and other financial information. | Would require reporting of actual compensation and explanations for material differences from initial estimates. |
| Compensation transparency | Establishes new PBM reporting and contract conditions alongside existing ERISA service-provider disclosure requirements. | Would specify upfront disclosures for PBM fees, manufacturer payments, spread compensation and other arrangements. |
| Rebates | Requires 100% pass-through of qualifying remuneration for covered arrangements, subject to statutory conditions. | Would require additional detail about manufacturer payments and PBM compensation. |
| Audit rights | Establishes audit protections for covered rebate arrangements. | Would add procedures for verifying compensation disclosures and addressing failures. |
| Scope | Covers specified group health plans and issuers, with reporting requirements varying by arrangement. | Focuses on PBMs and certain affiliated service providers serving ERISA-covered self-insured group health plans. |
| Timing | Key requirements generally apply beginning with plan years starting on or after August 3, 2028 (January 1, 2029, for calendar-year plans). | Not finalized as of October 5, 2026; requirements and applicability dates remain subject to change. |
How Can PBMs Prepare for New Disclosure Requirements?
The statutory requirements give PBMs a foundation for preparation, even while DOL’s final rule remains pending. Four areas deserve extra focus:
- Compensation data: Identify where rebate, spread, pharmacy payment and affiliate compensation information is captured, and whether it can be reconciled for reporting.
- Contracts: Review rebate arrangements, disclosure permissions, audit access and renewal dates against the statutory applicability timeline.
- Reporting capabilities: Map enacted data requirements to existing systems while keeping proposed disclosure fields and formats adaptable.
- Cross-team coordination: Establish how compliance, legal, finance, contracting and client reporting teams will review requirements and resolve data gaps.
PBMs can begin addressing gaps in data availability, contract terms and reporting capabilities without treating proposed requirements, such as DOL’s 5% compensation-variance threshold, as finalized obligations.
The Compliance Challenge Behind PBM Fee Disclosures
CAA 2026 makes PBM financial transparency a more demanding reporting obligation. Meeting those requirements will depend on more than producing reports. PBMs will need to reconcile compensation, rebates and pharmacy payments across systems, contracts and third-party relationships—and substantiate the figures they disclose.
DOL’s final rule will determine additional disclosure details, but it won’t eliminate that underlying data challenge. PBMs that assess their reporting capabilities and identify gaps now will be better positioned to meet the statutory deadlines and adapt to whatever requirements DOL finalizes.
ClearFile helps PBMs manage regulatory requirements through compliance monitoring, centralized documentation and streamlined workflows. Connect with us to see how we can support your regulatory operations.
