Federal regulators start to gather detailed PBM pay information
- IPMD
- Jul 8
- 1 min read
Reporter: Allison Bell
What You Need To Know
Congress put two sets of PBM rules in the Consolidated Appropriations Act, 2026 package.
One affects self-insured employer plans.
CMS is starting by implementing the other set of PBM rules, which affects Medicare drug plans.
The Centers for Medicare & Medicaid Services is giving employers and benefits advisors a sneak peek at how the new federal pharmacy benefit manager rules for self-insured employer health plans might work.
CMS staffers are showing how they think about PBM regulation in a new request for information posted Wednesday. The CMS staffers want to use the answers they get to implement a new, related set of rules for PBM efforts to serve Medicare Part D prescription drug plans.
Both the employer plan PBM rules and the Medicare plan PBM rules were created by sections of the Consolidated Appropriations Act, 2026, a big package of legislation that became law in February.
PBMs that serve Medicare plans will have to start complying with their new rules by July 1, 2028, officials say in the information request notice.
What it means: CMS can implement the Medicare plan PBM rules on its own. The U.S. Department of Health and Human Services agency will have to work with the Internal Revenue Service and the U.S. Labor Department's Employee Benefits Security Administration to implement the new employer plan PBM rules.
But the new request for information could provide clues about how CMS sees PBM issues... Continue Reading