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Your PBM Countdown Has Already Started: DOL Finalizes PBM Fee-Disclosure Rule

Your PBM Countdown Has Already Started: DOL Finalizes PBM Fee-Disclosure Rule

  • On November 2, 2026
DOL’s final rule on PBM fee disclosure was published in the Federal Register on November 2. It’s easy to look at an applicability date of July 1, 2027 and file it under “next year’s problem.” For plans with July 1 renewals, though, the real deadline is much sooner. In about five months, PBMs may need to deliver detailed compensation disclosures to those plans.

The date to circle: April 2, 2027

The rule applies to plan years beginning on or after July 1, 2027. PBMs and other covered service providers (CSPs) must give the initial disclosure “reasonably ahead” of entering into, renewing, or extending a contract. For renewals and extensions, DOL treats at least 90 days in advance as reasonable.
Counting back 90 days from July 1, 2027 gives you April 2, 2027. To get there:
  • PBMs have to build disclosures they’ve never produced before. That includes spread compensation by drug and pharmacy channel, manufacturer payments split into amounts passed through and amounts retained, and net pricing.
  • July 1 marketing and RFP work usually runs in the first quarter. If your clients want to compare PBMs using this new information, the conversations need to start in December and January.
  • For calendar-year plans, the first plan year under the rule is likely the one beginning January 1, 2028. Counting back 90 days puts initial disclosures around early October 2027. (This timing is based on DOL’s stated dates; check it against the Federal Register text.)

Who’s covered

The rule covers large self-insured group health plans. These are generally self-insured plans with 100 or more participants, or self-insured plans offered by employers with 100 or more employees. CSPs include any entity providing pharmacy benefit management services, whatever it calls itself, and PBM-affiliated brokers and consultants that expect $1,000 or more in compensation.
What fiduciaries will receive
  • Initial disclosures: These cover services; direct compensation; manufacturer payments; spread compensation; pharmacy recoupments (including copay clawbacks); price-protection arrangements; termination compensation; formulary-placement incentives; drug pricing methodology; fiduciary status; and audit rights.
  • Ongoing disclosures: These are due within 30 days after each semiannual period, or quarterly if the plan asks. If actual compensation runs 5% or more above the initial estimate, the CSP must explain why.
  • Format: Compensation must be expressed in dollars, written in plain language, and provided as a machine-readable file on request.
  • Audit rights: The plan can audit at least annually and choose its own auditor. The CSP must acknowledge the request within 10 business days and generally produce records within 60 days.
If a CSP fails to comply, fiduciaries can rely on a separate exemption. To do so, they must take specific steps, including notifying DOL if the CSP doesn’t fix the failure.

Already in effect: the CAA 2026 rules

The CAA 2026 amendments to ERISA ยง408(b)(2)(B) took effect February 3, 2026, and apply to service providers of all group health plans, including fully insured and smaller plans. Until the final rule applies, DOL will accept good-faith interpretations of those rules.

What to do now

  • Pull your July 1 renewals. Flag self-insured clients at or above the 100-participant/employee line.
  • Contact those PBMs before year-end. Ask whether they can deliver compliant disclosures by April 2, and whether they will provide machine-readable files.
  • Build April 2 into the renewal calendar as a firm milestone. Check that it doesn’t conflict with RFP decision dates.
  • Review contract terms for audit restrictions that conflict with the rule.
  • Check your own disclosures under the CAA 2026 rules.
  • Leave the legal judgments to fiduciaries and counsel. That includes whether compensation is reasonable and when to notify DOL.

Join us Monday

Useful Compliance Office Hours this Monday is all about the PBM Final Rule. We’ll go through the April 2 timeline, what a compliant disclosure looks like, and how to raise this with clients. Register here if you haven’t yet already, and bring your questions.
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