Harshbarger Applauds Historic Trump Administration Action to End Hidden PBM Fees and Increase Transparency 

Washington, D.C. — Congresswoman Diana Harshbarger (R-TN), Vice Chair of the Subcommittee on Health of the House Energy and Commerce Committee, released the following statement applauding the U.S. Department of Labor’s (DOL) final rule cracking down on hidden pharmacy benefit manager (PBM) fees. Under the rule, PBMs — the middlemen that manage prescription drug benefits — and their affiliated brokers must give employers that fund their own workers’ health plans a written breakdown of all the money they expect to make. That breakdown is due both when a contract is signed or renewed and every six months afterward. Employers also get the right to audit those numbers to make sure they are accurate:

“Where there's mystery, there's margin, and PBMs have made a fortune off both,” said Congresswoman Diana Harshbarger. “As a pharmacist for decades, I've watched these shadowy middlemen pad their pockets at the expense of patients, employers, and the community pharmacies that serve them. Employers footing the bill for their workers' healthcare have been kept in the dark about how PBMs really make their money. Thanks to President Trump and Secretary Sonderling, those days are over. Employers will finally see the hidden rebates, fees, and markups PBMs pocket — and they'll have the right to audit the books. That means better deals, lower prescription drug costs, and more money back in the pockets of American workers and their families.”

“This is a win for every American worker who has ever paid too much at the pharmacy counter,” said Secretary of Labor Keith Sonderling. “For years, PBMs have operated in the shadows, pocketing hidden fees while workers and employers were left in the dark. Today, President Trump is delivering the transparency Americans deserve – and putting American workers first.” 

“More transparency means more competition, and more competition means lower health care costs,” said Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz. “Today’s new rule represents a significant step forward in this Administration’s all-of-government effort to take the guesswork out of shopping for health care – an effort in which Labor, CMS, and numerous other agencies and departments all have important roles to play.”

BACKGROUND:

On November 2, the U.S. Department of Labor finalized a rule of the Employee Retirement Income Security Act (ERISA), the federal law that governs employer-sponsored health plans. The rule requires PBMs — the middlemen that negotiate drug prices and run prescription drug benefits for health plans — to disclose to employers exactly how they get paid. It covers large employers that pay for their workers’ healthcare directly instead of buying coverage from an insurance company. It also applies to the brokers and consultants tied to PBMs. President Trump first directed the Labor Department to propose stricter transparency rules in his April 15, 2025, executive order, “Lowering Drug Prices by Once Again Putting Americans First.” 

Under the rule:

• PBMs must give employers a written breakdown of all the money they expect to make from their contract — when the contract is signed or renewed, and every six months after that, or every three months if the employer asks.
• For the first time, PBMs must disclose three major sources of hidden profit: 
  • Rebates and other payments from drug companies; 
  • The “spread,” when a PBM charges a health plan more for a drug than it pays the pharmacy and keeps the difference; and 
  • Fees PBMs take back from pharmacies after a prescription is filled.
• Employers can audit the numbers to make sure they are accurate.
• The rule applies to employers with roughly 100 or more employees or plan members.

Self-insured employer health plans cover about 90 million Americans. The Labor Department projects the rule will lower prescription drug costs for plans and participants by as much as $22 billion over 10 years. The rule takes effect January 4, 2027, and applies to plan years beginning on or after July 1, 2027.

Congresswoman Harshbarger championed two bills that laid the groundwork for this rule:

• PBM Reform Act: Introduced in July 2025 with Congressman Buddy Carter (R-GA), the bipartisan bill would require PBMs to give employers and patients semiannual reports on drug spending, rebates and formulary decisions, and would decouple PBM compensation from drug prices in Medicare Part D. Provisions of the bill helped shape the PBM reforms President Trump signed into law Feb. 3 as part of the Consolidated Appropriations Act, 2026 — the law this rule implements. That law also requires PBMs to pass 100% of manufacturer rebates and fees through to employer plans for plan years beginning on or after August 3, 2028.
• PBM Sunshine and Accountability Act: Introduced in April 2023, the bill would require PBMs to report the rebates and fees they receive from drug manufacturers — including amounts they keep rather than pass through to health plans — and the payments they claw back from pharmacies, and would extend that reporting to employer group health plans. The Labor Department rule now requires PBMs to disclose many of the same categories of compensation directly to employers.

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