The US Department of Labor (DOL) intends to require pharmacy benefit managers (PBMs) to share information with self-insured group health plans.
A new rule proposed last week would require PBMs and other covered service providers to disclose the full range of services they provide and to report all compensation, including manufacturer payments.
The DOL said this will help fiduciaries of self-insured group health plans covered by the Employee Retirement Income Security Act (ERISA) to fulfill their statutorily mandated role to determine whether service contracts or arrangements with PBMs are reasonable.
PBMs provide a range of services for self-insured health plans such as organizing pharmacy networks, negotiating pharmacy reimbursement amounts and drug rebates, establishing drug formularies, and processing claims. The DOL referred to them as the “middlemen” in the pharmaceutical supply chain.
“When middlemen are forced to operate in the sunlight, American workers and their families win,” Labor Secretary Lori Chavez-DeRemer said in a statement. “Hidden fees and distorted incentives have no place in American healthcare.”
Employers may comment on the proposed rule through March 31. Comments can be submitted online under Regulatory Information Number (RIN) 1210-AB37 or by mailing written submissions to the DOL.
After the comment period ends, the DOL will respond to comments and possibly make revisions before publishing a final rule. This final rule will include a formal effective date, which generally must be no earlier than 30 days after its publication in the Federal Register.
