The Public Has Spoken: Responses to the Department of Labor’s Proposed PBM Rule Overwhelmingly Demand Further Transparency

When the Department of Labor (DOL) closed the comment window on its proposed PBM fee disclosure rule, the verdict was in: of the more than 560 comments, over 80% of letters expressed support for transparency, including from 180+ key stakeholders. A surge of 335 comments on the final day alone highlights just how much is at stake.

The PBM Accountability Project, along with more than 75 other organizations, support the proposed rule. Patient advocates, independent pharmacies, pharmaceutical manufacturers, employer groups, provider groups, and labor unions all arrived at the same conclusion: PBM business models are too opaque, and employers are paying the bill without being able to read it.

When groups like AARP, the National Association of Attorneys General, the National Association of Manufacturers, the Cystic Fibrosis Foundation, and Patients for Affordable Drugs are all on the same side of an issue, that is not a partisan grievance. It is a structural indictment of the PBM business model.

Supporters are not only asking DOL to finalize the rule; they are asking the Department to strengthen it by expanding disclosure requirements to PBM affiliates and subcontractors, guaranteeing standardized data reporting, and ensuring employers have the information they need to negotiate fair contracts. Among key supporters, three themes emerge:

1. Fiduciary duty requires PBM transparency: Plan sponsors cannot fulfill ERISA obligations without visibility into PBM compensation (e.g., rebates, spread pricing) and conflicts of interest.

2. PBM opacity harms patients and inflates costs: Rebate and formulary dynamics inflate patient cost sharing and limit access to prescribed therapies. PBM market concentration drives up costs.

3. Transparency levels the competitive playing field: Disclosure requirements create fair competition among smaller, transparent PBMs and the big three.

   
   

The opposition, including CVS Health, UnitedHealthcare, Cigna and PBM lobbying arm PCMA, revert to the same tired excuses to evade needed reform, claiming the rule is duplicative and that the implementation timeline is unworkable. Notably, none argue against transparency in principle.

DOL now has a clear record and a clearer mandate: finalizing a rule that is both comprehensive and actionable, one that complements existing law while ensuring accountability has real teeth. The public has done its part. The Department now must do the same and set the stage for comprehensive PBM reform that serves employers and their employees.

Learn more and read our one pager here.