45 State AGs Back DOL Rule for PBM Fee Transparency
A bipartisan group of 45 state attorneys general formally backed the DOL’s proposed PBM fee disclosure rule.
Why it matters: Widespread state AG support adds momentum to federal efforts targeting transparency in pharmacy benefit manager operations for employer health plans—a key compliance issue for counsel. Heightened scrutiny may increase regulatory complexity and drive reform in healthcare contracting.
- The coalition submitted its comment letter to the Department of Labor on April 15, 2026.
- The proposed rule compels PBMs working with ERISA-covered health plans to routinely disclose fees, rebates, and compensation.
- AGs asked DOL to ensure the rule does not preempt current state PBM transparency laws, favoring joint oversight.
- PBMs currently oversee about 80% of prescription drug claims in the U.S., giving them major pricing power.
A bipartisan coalition representing 45 state attorneys general delivered a formal comment letter on April 15 to the U.S. Department of Labor (DOL), voicing strong support for a federal rule to boost transparency around pharmacy benefit manager (PBM) fees. If finalized, the rule would directly impact employer-sponsored health plans regulated by ERISA.
- The DOL’s proposal, titled 'Improving Transparency into Pharmacy Benefit Manager Fee Disclosure', would require PBMs to provide detailed, regular disclosures about their revenue streams—including all fees, rebates, and compensation strategies—for plans governed by ERISA.
- The comment period for the rule—first issued on January 29, 2026—was extended to April 15 to accommodate input on new statutory changes from the Consolidated Appropriations Act, 2026.
- Attorneys general also urged the DOL to explicitly state that the rule would not override state transparency or consumer protection laws, advocating for coordinated federal-state enforcement to minimize uncertainty in the marketplace.
PBMs play a pivotal role, managing about 80% of U.S. prescription drug claims and exercising substantial control over drug pricing and pharmacy reimbursement. This regulatory push aims to address long-standing concerns regarding PBM business practices. As Oklahoma AG Gentner Drummond stated, “When Oklahomans and their employers are paying more for prescription drugs, they deserve to understand why.” Mississippi AG Lynn Fitch added, “PBMs have taken from the health care economy for far too long without giving back. It is past time that there is accountability and an increase in transparency.”
The DOL’s effort dovetails with broader federal moves to improve pharmacy supply chain transparency. Counsel overseeing compliance for employer health plans should closely monitor the rule’s trajectory and the evolving interplay between state and federal requirements.
By the numbers:
- 45 — Number of state attorneys general backing PBM fee transparency
- 80% — Portion of U.S. prescription drug claims managed by PBMs
- Jan. 29, 2026 — Date the DOL issued the proposed PBM fee disclosure rule
Yes, but: The DOL has not clarified how the new federal requirements will interact with existing state PBM transparency laws, raising questions for multijurisdictional compliance.
What's next: The timeline for final rule issuance and implementation has not been announced.