The Department of Labor’s proposal would force pharmacy benefit managers to disclose drug pricing details to employers and open their books to audits. More than 500 comment letters show PBMs and insurers fighting the rule, while some employers and startups back it and drugmakers offer mixed support.

• DOL's proposed rule would force PBMs to disclose rebates, fees, and spread pricing to employers and submit to audits
• Over 500 comment letters split along predictable lines: PBMs/insurers oppose it as exposing confidential contracts, while Cost Plus Pharmacy and business groups support it as curbing hidden markups
• Drugmakers back reining in PBMs generally but want the disclosure rules narrowed to administrative fees, excluding drug-specific rebate data that competitors could exploit
• Rule could shift negotiating power from PBMs to employers, though employers would then face more complex data to manage in contract talks