Requirements to provide new data to help employers assess the financial impacts of pharmacy benefit manager (PBM) agreements is incoming.
But while the Consolidated Appropriations Act, 2026 (CAA 2026) will require PBMs to hand plan sponsors detailed data on spread pricing, rebate flows, and cost structures by January 2029, a critical question remains unanswered.
Once that data arrives, who is actually responsible for understanding it?
That accountability gap is the central challenge facing plan sponsors, benefits brokers, and legal counsel as the industry prepares for one of the most significant pharmacy benefit reforms in years, according to Bryn White, an employee benefits attorney at Endeavor Law in Kansas City, Missouri, who’s been speaking with Insurance Business Benefits.
"Plan sponsors have wanted this data for years to see where the money is going and how much spread pricing there actually is," White said. "Now that we may get some of that, who is going to review it? Who is actually going to be going through it? Some plan sponsors won't know what those numbers even mean."
White frames the coming reform as genuinely meaningful but cautions that disclosure requirements alone do not guarantee economic change.
Plan sponsors are the fiduciaries of record under the Employee Retirement Income Security Act (ERISA), which means the legal obligation to interpret and act on PBM data ultimately rests with employers, not their service providers.
In practice, however, most plan sponsors lack the technical expertise to parse rebate mechanics or identify spread pricing anomalies without guidance from brokers, consultants, or third-party administrators (TPAs).
White expects federal agencies to issue fiduciary guidelines on data interpretation ahead of the January 2029 effective date but no formal deadline for that guidance currently exists.
"It's a great step," White said. "But with this transparency comes litigation, as we've seen on the retirement side. We're starting to see that over here now on the health side and as we have more transparency and another compliance checkbox, there comes more potential for that litigation."
The parallel to retirement benefits is instructive. ERISA fiduciary duty cases targeting employer health plans have accelerated in recent years, with suits like Lewandowski placing liability squarely on the plan sponsor – not the broker or the PBM. White cited that case specifically as a reason employers need to act now, not in 2028.
One of White's most pointed observations is that the 2029 deadline is not as distant as it appears.
Because most PBM contracts run approximately three years, some renewals happening today will overlap with the new requirements, meaning the terms being negotiated right now will govern what plan sponsors can and cannot access when CAA 2026 takes effect.
"Some of those renewals may be coming up and we may be hitting contracts that will go into that time," White said. "Are we already beginning to negotiate contract provisions to make sure they align with these new recommendations, new guidance? That's kind of the gray area right now."
White's guidance for brokers advising clients through current renewal cycles is to ensure PBM contracts include explicit data-access rights with no prohibition clauses, build in strong indemnification provisions that assign penalty responsibility between the PBM and the plan sponsor, and (where possible) involve legal counsel at the negotiation table rather than after the fact.
"With some of the penalties – they're large," White said. "Who is responsible for those? Making sure we write that into the contract with the PBM. Will the PBM accept responsibility for those penalties, or is it going to fall on the plan sponsor?"
For a deeper look at how CAA 2026's PBM provisions affect plan sponsor obligations, IBB has covered the legislative timeline in detail.
White acknowledged the concern that large PBMs – which carry significant financial and lobbying resources – could dilute implementing guidance before the 2029 effective date is reached.
But she expressed cautious optimism, pointing to recent Federal Trade Commission (FTC) settlements with major PBMs as evidence that regulatory momentum is building across multiple agencies simultaneously.
"I think we have a little more on our side following some of these FTC settlements," White said. "I think we're kind of getting something from multiple sides to try to regulate the pricing a little bit more."
Beyond federal action, some states are pursuing their own approaches and attempting to restrict which PBMs can operate within their borders, with the Big 3 as the explicit target. White noted that legal gray zones and anticipated litigation make that avenue uncertain, but the effort reflects broader market dissatisfaction with dominant PBM pricing practices.
That dissatisfaction is also showing up in purchasing behavior. White confirmed observable attrition from the Big 3 toward smaller, more transparent PBMs. "While it may not be as big of a difference, it can still be beneficial," she said.
The FTC's interim report on pharmacy benefit managers, published by the Federal Trade Commission, found that the largest PBMs used their market position to steer patients toward their own affiliated pharmacies, raising costs for plan sponsors and participants alike.
White's practical advice for benefits brokers is built around a four-part framework for proactive engagement with plan sponsors today:
First, communicate that the January 2029 effective date is real and unlikely to move. She does not expect significant delay, reasoning that the primary implementation burden falls on PBMs – which must build data-gathering and reporting systems – rather than on federal agencies that would need new infrastructure. "I wouldn't think they would push it back much later," she said.
Second, audit current PBM contracts now for data-access rights and prohibition clauses. Any renewal entering a three-year term today should be treated as a CAA 2026 contract.
Third, involve legal counsel in initial contract negotiations – not just compliance reviews after the fact. Given the size of potential penalties and the volume of unresolved questions, White argues that broker advisory scope alone is insufficient for this moment.
Fourth and perhaps most structurally significant, encourage plan sponsors to form health plan fiduciary committees, mirroring the governance model that has become standard on the retirement side.
"Consider creating that with some of those plan sponsors you work with, and how can we educate them and train them on fiduciary duties like we do on the retirement side," White said.
The Department of Labor (DOL) guidance on group health plan transparency under the CAA remains a key reference point for brokers structuring client conversations ahead of 2029.
For brokers looking to benchmark their approach, IBB's coverage of PBM reform and the broker fiduciary checklist offers additional context on how advisory firms are positioning themselves ahead of the deadline.
White's overarching message is that plan sponsors and the brokers who serve them cannot afford to treat January 2029 as a future problem.
"The 2029 date should be on your radar," she said. "We need to make sure that in our contracts with the PBMs, we have access to this data and there's nothing prohibiting us from getting access."
