The House has added measures to the Consolidated Appropriations Act (CAA), 2026, an appropriation bill or spending package, that include transparency requirements for PBMs. These requirements are included in a provision designed to lower drug costs by giving drug manufacturers more tools to secure approval for generic drugs from the U.S. Department of Health and Human Services (HHS). The provision would also add to an existing list of entities that the Employee Retirement Income Security Act (ERISA) requires health plan fiduciaries to monitor.
More specifically, the provision would require PBMs to provide fiduciaries with prescription drug benefits-tracking reports, which would allow fiduciaries to measure the cost-effectiveness of these benefits for plan participants. Furthermore, PBMs would be required to pass all rebates and other negotiated discounts on to plan fiduciaries, rather than retaining them. Finally, “covered service providers,” or entities involved in prescription drug benefit programs, would be required to undergo audits by plan fiduciaries.
Currently, ERISA requires fiduciaries to track entities that help with “development or implementation of plan design.” Under the new provision, fiduciaries would have to track service providers that assist with: plan design, insurance or insurance product selection (including vision and dental), recordkeeping, medical management, benefits administration selection (including vision and dental), stop-loss insurance, pharmacy benefit management services, wellness design and management services, transparency tools, group purchasing organization agreements and services, participation in and services from preferred vendor panels, disease management, compliance services, employee assistance programs, or third-party administration services, or consulting services related to any such services.
However, the PBM provisions in the current draft of the bill do not classify PBMs as fiduciaries or dictate their compensation structures.
More generally, the spending package does not address private-sector retirement benefits, health savings accounts, individual coverage health reimbursement arrangements, or the premium subsidies for Affordable Care Act (ACA) health insurance plan participants that expired at the end of 2025. However, the bill does include $42.1 million in funding to enforce the No Surprises Act (NSA). The NSA aims to protect insured patients who receive out-of-network emergency care or out-of-network care from in-network hospitals from being charged for out-of-network care.
The main purpose of the CAA, 2026, was to fund a portion of the federal government’s normal operations after January 30, 2026, and avert a partial government shutdown. Signed into law on February 3, 2026, it allocates about $1.2 trillion in funding to diverse programs covering defense, public health, medical research, college financial aid, and other areas unrelated to employer-sponsored health benefits.
The CAA, 2026, allocates $3.7 billion to the Centers for Medicare and Medicaid Services (CMS), which oversees public and private health programs. Another $191 million would go to the Employee Benefits Security Administration (EBSA), a division of the U.S. Department of Labor.
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