A bill that moved out of House committee in May 2026 would ban pharmacy benefit managers from paying referral fees or other compensation to brokers, consultants, and advisors who steer employer-sponsored health plan business toward a particular PBM, putting a long-contested compensation practice in the regulatory crosshairs.
The PBM Kickback Prohibition Act (H.R. 7895), introduced by Rep. Rick Allen (R-GA) and advanced by the House Education and the Workforce Committee on May 21, would amend the Employee Retirement Income Security Act (ERISA) to prohibit such arrangements. During an April 2026 committee hearing, Rep. Allen cited deceptive payment practices between PBMs and brokers, alongside a broader lack of industry transparency, as the driving reasons behind the bill. The measure was placed on the Union Calendar after committee markup, though no Senate companion bill has been identified in the legislative record.
Under its terms, any payment from a PBM to a brokerage firm, broker, consultant, or advisor - regardless of how that payment is labeled - would be presumed a violation unless the parties can demonstrate it is not tied to a prohibited referral activity and reflects fair market value for a legitimate service. The ERISA Industry Committee, which represents large self-insured employers, has been among the bill's most vocal institutional backers.
The National Association of Benefits and Insurance Professionals (NABIP) raised concerns during the April 2026 hearing, warning that the bill's broad language could inadvertently capture payments tied to legitimate services - including marketing, implementation, and ongoing support of employer PBM plans - rather than purely referral-based steering. The live debate, in other words, is not whether steering payments should be prohibited, but where the line sits between a prohibited referral fee and a permissible service fee. The bill as advanced by committee places the burden on the parties to demonstrate that distinction.
The legislation arrives as employer confidence in the traditional PBM model is eroding at a pace that was not anticipated even a year ago. The 2026 Pulse of the Purchaser survey, published by the National Alliance of Healthcare Purchaser Coalitions, found that the Big Three PBMs - CVS Caremark, Express Scripts, and Optum Rx - saw their collective share of the employer market fall from 63.4% in 2025 to 54.3% in 2026. More than half of employers are still using one of the three, indicating they were considering switching within the next one to three years.
Employers have been pushing back on PBM rebate arrangements and spread pricing for years, and that frustration has accelerated the shift. The Consolidated Appropriations Act, 2026 (CAA 2026), signed on February 3, requires PBMs to pass through 100% of rebates to qualifying self-funded ERISA plans, eliminates spread pricing, and mandates detailed semiannual drug pricing and compensation disclosures to plan sponsors. The Department of Labor has since proposed a complementary rule requiring PBMs to make additional compensation disclosures to plan fiduciaries.
Each of the Big Three has now announced pricing models moving away from rebate-linked and spread-pricing arrangements. Optum Rx announced in May 2026 what it described as a fully transparent, fee-based model replacing traditional pricing tied to manufacturer list prices or prescription volume with per-member monthly fees. Express Scripts committed to a rebate-free, pass-through model to be standard for all clients by 2028. CVS has signaled movement toward cost-plus pharmacy reimbursement.
The scope and timing of implementation vary across the three companies, according to Mintz's Fall 2026 PBM Policy and Legislative Update, published by a firm that represents PBMs and health plans as advisory clients.
Running alongside the transparency push is a separate shift in how employers are structuring drug benefits. Several platforms launched in early 2026 that allow employers to offer workers access to high-cost medications, particularly GLP-1 drugs for weight loss and diabetes, without routing those benefits through a traditional PBM.
GoodRx launched its Employer Direct platform in February 2026, enabling employers to subsidize manufacturer cash-pay prices at the pharmacy counter. Eli Lilly's Employer Connect platform, launched in March 2026, offers Zepbound at a list price of $449 per month through a dedicated pharmacy network paired with more than 15 independent program administrators.
These arrangements reflect pressure building from multiple directions: employer demand for more predictable drug benefit costs, growing employee interest in GLP-1 access, and manufacturers seeking to reach patients who lack formulary coverage. They also sit outside the standard PBM request-for-proposal process entirely, which means advisors evaluating them for employer clients are working without the contractual benchmarks - rebate pass-through rates, spread pricing comparisons, formulary terms - that anchor a traditional PBM procurement.
Whether the PBM Kickback Prohibition Act clears the full House and advances through the Senate remains an open question. No companion bill has been introduced there. What is less uncertain is the direction of travel. The 2026 Pulse of the Purchaser survey found that employers without full pharmacy claims access were more than twice as likely to express concern about PBM compensation and administration as those with full access. As that data gap closes, through the CAA 2026's disclosure mandates, the conversations employers are having with their advisors about fees and conflicts are likely to become more pointed.
