PBM Reform Raises Employer Oversight Pressure Before Final Rules Are Settled

US-Rx Care says early-2026 PBM action elevated disclosure, auditability, and fiduciary accountability, even as many of the contract structures and revenue streams that drive employer drug costs remain in place. 

HOLLYWOOD, Fla., May 26, 2026 /PRNewswire/ -- With PBM reform moving from policy debate to active scrutiny, US-Rx Care says self-funded employers are facing a more demanding oversight environment even though many of the mechanisms that drive pharmacy overspend remain intact. For plan sponsors entering renewal season, the issue is no longer simply whether PBMs are under pressure. It is whether employers can justify renewing into contracts that preserve the same conflicts regulators, lawmakers, and purchasers are now questioning. 

"The story now is not just that PBMs are under pressure," said Renzo Luzzatti, CEO of US-Rx Care. "It's that employers are also under pressure to prove they are buying and governing pharmacy benefits prudently, even before the final reform picture is clear."

Reform Raises the Stakes for Employers 
Early this year, Congress enacted PBM-related reforms in the Consolidated Appropriations Act of 2026. The Department of Labor also proposed a PBM fee-disclosure rule for Employee Retirement Income Security Act (ERISA) self-insured plans, while employer groups publicly backed stronger claims-data access. Add the FTC's February settlement with Express Scripts, the employer story has evolved beyond generic PBM criticism. It is now a fiduciary and governance issue, especially for CFOs, CHROs, benefits committees, and procurement teams responsible for overseeing pharmacy spend. 

US-Rx Care argues that the proposed transparency and reporting requirements would not take effect until 2028 and, like earlier disclosure efforts, may be heavily litigated or never implemented. That leaves employers in a difficult position: expectations around oversight are rising now, while the final legal and regulatory framework is still being worked out. 

Why Reform Headlines Do Not Equal Protection 
Many of the structural levers that inflate employer drug spend still appear to remain in place. According to US-Rx Care, these include vertically integrated pharmacy ownership, exclusive arrangements that lock plans into PBM-controlled services, rebate-linked economics, prior authorization control, and contract terms that allow PBMs to profit when overall plan costs rise. That disconnect is what makes the current moment risky for employers: reform headlines can suggest the market is getting safer, even while the underlying economics remain largely unchanged. 

US-Rx Care says the most important disclosures are often the ones legacy PBM arrangements resist most such as total PBM revenue from all sources, manufacturer revenue by any definition, including discounts tied to drugs dispensed through PBM-owned pharmacies, and compensation paid to third parties. The company says those hidden revenue streams are often the source of conflicts working against plan sponsors and plan members. 

"Before employers can fix the economics, they have to see the economics," Luzzatti said. "Who gets paid, how they get paid, and whether higher plan spend still produces higher PBM profit. Those are the questions that matter." 

What Employers Should Demand in the Next Renewal 
US-Rx Care believes that employers need to move beyond transparency of language and toward fiduciary standards. "Transparency is not a legal term. It can mean whatever the PBM wants it to mean," Luzzatti said. "Fiduciary, by contrast, has a legal definition under ERISA. If a PBM is not obligated to act in the plan's best interest, then transparency alone does not solve the conflict." 

For employers evaluating a prudent 2026 PBM renewal process, the key questions are straightforward:

• Is the PBM fully aligned with the employer's fiduciary obligations under ERISA? 
• Does the PBM make more money when plan costs rise?
• Does the PBM own retail, mail, or specialty pharmacies that the plan is incentivized or required to use?
• Can the best interests of the plan negatively affect the PBM's profits?

These questions separate true employer protection from performative transparency. 

US-Rx Care says employers should closely examine contract language that 

• explicitly states the PBM is not a fiduciary
• limits fiduciary duties to claims or appeals functions
• restricts the use of third-party solutions 
• preserves exclusive control over clinical services and dispensing channels
• Permits spread pricing 
• defines rebates too narrowly to capture all manufacturer revenue.

In the company's view, those are the provisions that often preserve PBM leverage even in a reform-heavy environment. 

US-Rx Care maintains that a fiduciary PBM model changes the structure in ways proposed reforms still may not. It points to no conflicts of interest, no pharmacy ownership, no hidden markups or spread pricing, no retained manufacturer revenue, simple administrative fees as the sole source of revenue, formularies designed around clinical and financial parameters to drive the lowest net cost, and open pharmacy networks that allow plans to access lower-cost sources when appropriate. 

"Government action has made one thing clear: turning a blind eye to well-documented PBM conflicts is no longer a tenable strategy," Luzzatti said. "But employers do not have to wait for every rule to be finalized or every case to be litigated. They can demand fiduciary alignment now and remove those conflicts directly from the way they purchase pharmacy benefits." 

About US-Rx Care 
US-Rx Care is revolutionizing America's pharmacy benefits system by replacing opaque, profit-driven PBMs with a transparent, fiduciary model that puts employers and members first. Founded in 2007, the company combines clinical rigor, ethical contracting, and data-driven oversight to cut drug costs by up to 50% or more while also improving health outcomes. Operating under a legally binding ERISA fiduciary standard, US-Rx Care eliminates conflicts of interest, passes through 100% of manufacturer rebates and pharmacy discounts, and delivers measurable savings without compromising care. Privately owned and free from outside financial influence, US-Rx Care is setting the new standard for pharmacy benefit management—restoring trust, accountability, and real control for employers, benefits consultants, and health plans nationwide. Website: www.us-rxcare.com 

References: 

• U.S. Department of Labor. (2026, January 29). US Department of Labor proposes historic pharmacy benefit manager fee disclosure rule. Dol.gov/newsroom/releases/ebsa/ebsa20260129 
• U.S. Department of Labor. (2026, January). Fact sheet: Proposed pharmacy benefit manager fee disclosure rule. dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/proposed-pharmacy-benefit-manager-fee-disclosure-rule 
• Federal Register. (2026, March 2). Improving transparency into pharmacy benefit manager fee disclosure: Extension of comment period. federalregister.gov/documents/2026/03/02/2026-04084/improving-transparency-into-pharmacy-benefit-manager-fee-disclosure-extension-of-comment-period
• Federal Trade Commission. (2026, February 4). FTC secures landmark settlement with Express Scripts to lower drug costs for American patients. ftc.gov/news-events/news/press-releases/2026/02/ftc-secures-landmark-settlement-express-scripts-lower-drug-costs-american-patients 
• Consolidated Appropriations Act, 2026, H.R. 7148, 119th Cong. (2026). govinfo.gov/app/details/BILLS-119hr7148enr 
• The ERISA Industry Committee. (2026, April 16). Employers support historic PBM transparency proposed rule and call for full claims data access. eric.org/press_release/employers-support-historic-pbm-transparency-proposed-rule-and-call-for-full-claims-data-access/

Media Inquiries:

Karla Jo Helms
JOTO PR^™ 
727-777-4629
Jotopr.com

SOURCE US-Rx