Sponsors (2)
The bill increases transparency and fiduciary tools around health-plan contracting and PBM/TPA practices—potentially lowering costs and improving oversight and care coordination—but it also imposes new compliance and administrative burdens, may reveal or withhold sensitive commercial information, and could create contractual and cost trade-offs for providers, employers, plans, and consumers.
Patients and group health plans gain more detailed PBM and TPA disclosures that give plan sponsors and fiduciaries better information to oversee drug pricing, formularies, and contracting—potentially enabling cost savings and improved oversight.
Plan sponsors and employers (including small businesses and hospitals) get clearer authorization to contract a wider range of benefits-related services (e.g., PBM, stop-loss, wellness, recordkeeping), increasing flexibility in plan design and access to specialized services like disease management and EAPs that can improve care coordination.
Plan fiduciaries receive more granular 'by service' fee disclosures, making it easier to assess the reasonableness of individual service fees and compare vendor value.
Covered service providers, PBMs, and insurers will face new compliance costs to produce annual disclosures and implement privacy controls; those costs could be passed on to consumers, plan participants, employers, or taxpayers.
Expanding the list of permissible contracted services and exemptions could widen opportunities for conflicts of interest and allow hidden revenue streams, potentially increasing costs for plan participants and weakening fiduciary oversight.
Eliminating the option to disclose fees in the aggregate forces per-service reporting that increases administrative burden for small employers and could reveal commercially sensitive pricing, provoking provider resistance or higher administrative costs.
Based on analysis of 4 sections of legislative text.
Requires service-level fee disclosures and new annual PBM/TPA disclosures for group health plan service providers, and directs DOL to issue implementing rules within one year.
Introduced March 11, 2025 by Joe Courtney · Last progress March 11, 2025
Changes ERISA’s exemption rules to require more granular, service-by-service fee disclosures for group health plan service providers, expands the list of contractable services, and adds new, PBM- and TPA-specific annual disclosure obligations to plans and fiduciaries. It also treats certain PBM arrangements as indirect plan transactions for prohibited-transaction purposes and directs the Department of Labor to write implementing rules within one year to standardize expected-compensation disclosures.