Senate passes $1.2T 'minibus' spending package that includes employer PBM transparency provisions

Observers have dubbed the legislation a "minibus" package, because it is serving as a vehicle for moving so many other pieces of funding legislation through Congress.

The package: An employer PBM transparency provision would require PBMs to provide detailed prescription benefits information for employers and other employer health plan fiduciaries, and another provision would require employers' PBMs to pass all rebates and other discounts negotiated on to the plan sponsors or plan participants.

A third provision would require PBMs that serve Medicare prescription drug plans to send those plans' managers detailed prescription benefits operations data.

The Senate process: Senate Majority Leader John Thune needed 60 votes to move ahead with consideration of the package.

Some Republicans in the Senate objected.

Related: PBM transparency mandates in spending bill hit Senate roadblock

Thune overcame the objections by agreeing hold a separate vote on $64 billion funding for the U.S. Department of Homeland Security and the DHS U.S. Immigrations and Customs Enforcement law enforcement agency, and by agreeing to hold a series of roll call votes on amendments related to topics such as refugee assistance funding and earmarks, or sections that would provide funding for specific projects.

The DHS funding provision would provide a few weeks of funding for the department, to keep it running while Democrats and Senators debate proposals for imposing new rules on ICE immigration enforcement efforts.

The House process: The House passed a version of the minibus appropriations package Jan. 22 by a 341-88 vote.

The House is out of session today and not planning to return until Monday.

At press time, appropriations package supporters were expecting the House to consider the revised package Monday.

If the House approves the package Monday and President Donald Trump signs it, the federal government would experience a brief, partial government shutdown that would have little impact on the affected agencies' operations.

If the House votes against the package or the president vetoes it, government agencies might go through a longer partial shutdown while negotiators work on a new deal.

Reactions: Adino Barbarito, a lawyer with Frier Levitt who commented on the efforts of the Senate Finance Committee staffers who drafted the PBM provisions included in the current version of the legislation, said in an email that the PBM provisions would have a big impact on employers' use of PBMs.

Under the employer rebate pass-through provision, "no arrangement with a PBM is 'reasonable' unless 100% of rebates, fees and price-related remuneration are passed through to the plan," Barbarito said.

The employer audit rights included in the provision are robust, Barbarito added.

Christine Johnston, general manager of the MacroHealth Pharmacy Solutions Marketplace, said in an email that she believes the rebate pass-through provision in the legislation would not work because it would fail to rein in PBMs' group purchasing organizations.

"These GPOs are separate legal entities that negotiate directly with the manufacturers, retain a portion of the funds and then pass the remainder to the PBM," Johnson said. "Because this legislation only restricts how PBMs are paid — not how GPOs are compensated — it leaves a significant loophole. PBMs will allow their GPOs to retain a larger share of manufacturer payments, thereby preserving the same incentives the reform seeks to eliminate.

The new draft U.S. Department of Labor PBM regulations: One open question is how the CAA, 2026 employer PBM provisions would interact with the PBM reporting and audit provisions in a major batch of draft employer PBM transparency regulations that EBSA published in the Federal Register today.

EBSA officials indicated in the preamble that they intend to be tough on service providers that say they are exempt from the proposed pharmacy benefits data reporting requirements.

This article has been updated to reflect the Senate vote on the CAA, 2026 package.