Sponsors (2)
The bill increases transparency and fiduciary oversight of PBM, TPA, and service‑provider compensation and accelerates rulemaking, potentially lowering hidden costs and improving benefits management — but it also raises compliance and administrative costs, risks expanded conflicts of interest, could expose commercially sensitive pricing, and may constrain some contracting practices.
Plan sponsors, fiduciaries, and patients receive more detailed PBM/TPA and per-service fee disclosures for the prior plan year, improving fiduciary oversight of drug pricing, formularies, and service costs and enabling better oversight and potential cost savings.
Employers and plan sponsors (including small businesses and hospitals) can contract a wider range of benefits-related services (PBM, stop-loss, wellness, recordkeeping, disease management, EAPs), enabling more specialized care coordination and expanded benefits options.
Required privacy safeguards for disclosed PBM/TPA information protect patients' health data and align disclosures with HIPAA and HHS breach-notification rules, reducing risk of PHI misuse.
Covered service providers, PBMs, insurers, and ultimately consumers, plan participants, or taxpayers face new compliance and privacy-control costs to prepare annual PBM/TPA and pay disclosures, which are likely to be passed along in higher administrative costs or prices.
Expanding the list of permissible contracted services increases the potential scope for conflicts of interest or hidden revenue arrangements within new service types, which could raise costs for plan participants and employers.
Removing the option to disclose fees in the aggregate and requiring 'by service' breakdowns increases administrative burden for small employers and fiduciaries and may force disclosure of commercially sensitive pricing that provokes provider resistance or higher prices.
Based on analysis of 4 sections of legislative text.
Requires service‑level fee and PBM/TPA annual disclosures for group health plans, treats PBM arrangements as indirect furnishings under ERISA, and directs DOL rulemaking within one year.
Official title: To amend the Employee Retirement Income Security Act of 1974 to clarify and strengthen the application of certain employer-sponsored health plan disclosure requirements.
Introduced March 11, 2025 by Joe Courtney · Last progress March 11, 2025
Requires more detailed, service‑level fee disclosures and new annual reporting when pharmacy benefit managers (PBMs) or third‑party administrators (TPAs) provide services to group health plans, narrows the option to disclose aggregate fees, and expands the list of plan services that may be contracted. It also treats PBM arrangements as indirect furnishing for certain ERISA prohibited‑transaction rules and directs the Labor Department to complete notice‑and‑comment rules within one year to standardize disclosure of expected compensation.