Changes Abound for PBMs, Plan Sponsors, Health Plan Vendors and Prescription Drug Plans

Within the span of a few days, a stunning number of changes have occurred that will affect the legal and fundamental business structures related to employer-sponsored prescription drug plans. These changes will most directly impact pharmacy benefit managers (PBMs) and the provision of prescription drug benefits. The changes, however, go well beyond PBMs and prescription drug plans, potentially impacting nearly all health plan vendors. Some of these changes have an immediate impact, while the full effect will take years to unravel.

In this article series, we describe these very important changes, breaking them down into four separate categories and identifying outstanding questions and action items for plan sponsors for each:

1. Proposed regulations related to PBM compensation disclosures that were published on January 30, 2026 (Proposed Regulations).
2. Consolidated Appropriations Act 2026 (CAA 2026) changes.
3. A settlement between the Federal Trade Commission (FTC) and Express Scripts, Inc. (Settlement).
4. The launch of the new TrumpRx.gov website.

Some initial thoughts:

• First, and perhaps most importantly, plan sponsors can expect to receive a flood of new information and data due to the Proposed Regulations, CAA 2026 and the Settlement. Much of that information will be very detailed (e.g., average costs for various prescription drugs) and, we suspect, will be difficult for a typical plan sponsor to decipher. Nonetheless, prudent fiduciaries will need to review this data – likely with the assistance of a consultant – and confirm the reasonableness of the fees paid to the vendor.
• Plan sponsors will also need to be proactive in ensuring their service providers supply the required disclosures to satisfy their fiduciary obligations.
• The Proposed Regulations are not integrated with the CAA 2026 requirements. Thus, there is overlap in several places. Presumably, the Department of Labor will modify the Proposed Regulations in the coming months to harmonize them with the CAA 2026 requirements.

This series summarizes important key changes and considerations. If you have questions about how all these changes impact your group health plan, contact your Reinhart attorney.