PBM transparency mandates come to life in $1.2T House spending package

In addition to enacting the PBM provisions, the CAA 2026 package provides $192 million in funding for the U.S. Department of Labor's Employee Benefits Security Administration.

The CAA 2026 package also includes thousands of appropriations provisions needed to keep much of the federal government operating normally.

The previous appropriations legislation for those parts of the federal government expired Jan. 30. Parts of the federal government shut down Saturday because of the expiration of the funding legislation.

The employer PBM provisions: One employer PBM transparency provision in the CAA 2026 package calls for PBMs to send employer health plan fiduciaries detailed prescription benefits operations data. The fiduciaries are supposed to use the data to verify that compensation levels for PBMs and other pharmacy benefits players are reasonable.

Another provision calls for the PBMs and other pharmacy benefit players to pass all rebates and other discounts on to employer plans and plan participants.

The employer PBM transparency provision does not classify the PBMs themselves as employer plan fiduciaries.

West Virginia insurance regulators recently posted a report showing that a state PBM rebate pass-through mandate cut 2025 group health premium increases to 9.6%, from 16.8%.

A Medicare PBM provision calls for PBMs serving Medicare Part D prescription drug plans to send them detailed information.

Reactions: Christine Johnston, general manager of the MacroHealth Pharmacy Solutions Marketplace, has predicted that PBMs will get around the employer PBM rebate pass-through provision in the package by using group purchasing organizations — legally separate entities that negotiate directly for discounts with drug manufacturers — to keep some of the funds that now go under the rebate heading.

Farheen Dam, Aon's head of health solutions, said in a commentary that employers should see the package as a call to pay more attention to their PBMs.

"Passage of PBM reform signals a major shift toward far greater transparency and accountability in the pharmacy ecosystem," Dam said.

The new access to PBM data will raise expectations for how employers manage pharmacy risk, Dam added.

DOL Regulations: The U.S. Department of Labor and its Employee Benefits Security Administration last week proposed employer PBM data reporting regulations that appear to be comparable to the employer PBM transparency section in the spending package.

Related: DOL proposes PBM transparency mandate for self-insured plans

One open question is whether any of the requirements in CAA 2026 might conflict with the provisions in the draft regulations and, if so, how the conflicts might be resolved.

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.

The history: The federal government started its 2026 fiscal year Oct. 1.

House Republicans ended up moderating the big 2026 budget cuts originally requested by the White House and kept 2026 appropriations for agencies like EBSA about even with what they were in 2025.

Some Democrats once hoped to use the appropriations process to persuade Republicans to leave the premium subsidy levels for people who buy indivdual and family major medical coverage through the Affordable Care Act public exchange system at the high levels in place in 2025, which were the result of a temporary boost provided during the COVID-19 pandemic. The temporary boost expired Dec. 31, 2025, and caused out-of-pocket health 2026 coverage costs for some older, relatively high-income enrollees to increase to four or five times what they were in 2025.

But the House ended up passing its first version of the package by a 341-88 vote, with many of the votes coming from Democrats as well as from Republicans.

When the package moved to the Senate, Democrats hoped to use the appropriations process to protest federal immigration enforcement efforts.

The Senate compromised by putting funding for the U.S. Department of Homeland Security in a separate bill. The Senate ended up passing the rest of the spending package by a 71-29 vote.

In the House, 21 Republicans went against the wishes of Republican congressional leaders and voted against the spending package, but 21 Democrats crossed party lines to vote for the package and get it through the House.