PBM Policy and Legislative
Update — Fall 2026

Mintz’s Managed Care, PBMs & Pharmacies practice is pleased to present its quarterly publication, PBM Policy and Legislative Update. This issue examines key federal and state developments from mid-February 2026 through June 2026 impacting PBMs and the broader prescription drug supply chain. Highlights include: Federal and state legislative activity, regulatory and enforcement developments, and significant litigation Emerging market trends affecting PBMs, health plans, pharmacies, manufacturers, and other industry stakeholders We hope you find the PBM Policy and Legislative Update to be a useful resource. For more information or to discuss how these developments may impact your organization, please contact us at [email protected]. Download the Mintz PBM Update

The PBM regulatory landscape is rapidly evolving at both federal and state levels, making it critical for our clients involved in the PBM space to stay apprised of developments in the industry as they happen. Our team actively monitors these developments in order to provide you with this quarterly PBM Policy and Legislative Update. This update builds on prior issues and highlights federal and state activity from mid-February 2026 to June 2026.

Federal Legislative Activity and Oversight

Federal Legislative Activity

Although Congress included landmark PBM reform in the 2026 Consolidated Appropriations Act passed on February 3, 2026, legislators continue to introduce bills targeting the PBM industry and PBM-related practices. Below is a summary of federal legislative activity from mid-February through June 2026.

INSULIN Act (S. 4189). The INSULIN Act of 2026 would prohibit private-market group health plans and insurers from applying any deductible to selected insulin products and cap the cost of a 30-day supply of insulin at $35 for plan years beginning on or after January 1, 2027; and for plan years beginning on or after January 1, 2028, the cap would drop to the lesser of $35 or 25% of the plan’s or insurer’s net negotiated price. The bill also would require PBMs, third-party administrators, insurers, and other entities providing PBM services to pass through 100% of all rebates, fees, and other remuneration received from drug manufacturers or other third parties that are related to the plan’s insulin utilization. For uninsured patients, the bill would establish a 10-state, 5-year pilot program through which each selected state would receive grant funding to help uninsured individuals access insulin at an “affordable” price. The bill defines “affordable” as an out-of-pocket cost of not more than $35 for a one-month supply.

PBM Kickback Prohibition Act (H.R. 7895). The PBM Kickback Prohibition Act would amend ERISA to prohibit PBMs from directly or indirectly providing referral fees or other compensation to brokers, consultants, advisors, or similar parties for steering employer-sponsored health plan or health insurer business to a particular PBM. However, the bill does not specify penalties (monetary or otherwise) for violations. During an April committee hearing about the PBM business model, the bill’s sponsor, Rep. Rick Allen (R-GA), cited deceptive payment practices between PBMs and brokers and a broader lack of industry transparency as driving reasons for the bill.

Every Dollar Counts Act (H.R. 8270). Recognizing the increased availability and use of direct-to-consumer platforms for pharmaceuticals, the Every Dollar Counts Act would require commercial insurers and group health plans to count a patient’s out-of-pocket spending on covered drugs (i.e., those on the plan’s formulary) toward their plan deductible and out-of-pocket maximum, regardless of where the drug is purchased. This approach would align with the one taken by the FTC in its February 2026 settlement with Express Scripts, which requires the PBM to count patient payments through the TrumpRx platform toward the patient’s deductible and out-of-pocket maximums. While proponents of the bill maintain that all patient out-of-pocket drug spending should be treated equally, others note that imposing such requirements on insurers’ benefit designs could lead to unintentional consequences, such as increased premiums.

Patients Before Monopolies Act (S. 4509 / H.R. 8779). As we discussed, the reintroduced Patients Before Monopolies Act retains the core prohibition on direct or indirect ownership or control of both a pharmacy and an insurance company or PBM, with a few new enhancements. The updated version accelerates the timeline for compliance (reducing the divestment period to one year), introduces stronger enforcement provisions (including divestment milestones and an escrow requirement for missed milestones), and creates a private right of action with a possible award of treble damages. It also requires the Federal Trade Commission (FTC) and Department of Justice (DOJ) to submit quarterly reports to the relevant congressional committees on compliance with the Act. These changes align the bill more closely with the Break Up Big Medicine Act, which similarly restricts common ownership of certain medical services providers.

Health Data Access, Transparency, and Affordability Act (H.R. 9228). The Health Data Access, Transparency, and Affordability Act would amend ERISA to require that service agreements between group health plans and network service providers (or other entities) give plan fiduciaries the right to access all relevant claims and encounter data, along with supporting documentation such as medical records and policy documents. All required disclosures would remain subject to HIPAA. The bill also specifies a number of prohibited provisions within contracts between group health plans and service providers, including limitations on the amount of claims or encounter data that the plan fiduciary may access. Parties violating the disclosure obligations would be subject to a civil monetary penalty of up to $10,000 per day per violation.

Other Federal Regulatory Activities

CMMI Advances Several Drug Pricing Models. As discussed in our Spring 2026 PBM Update, the Center for Medicare & Medicaid Innovation (CMMI) recently announced several alternative drug pricing models aimed at reducing prescription drug costs. The public comment period for the mandatory GUARD and GLOBE models closed in late February 2026, with a limited number of public comments released. Both models have since advanced in the regulatory process, with the GUARD and GLOBE final proposed rules submitted to the White House’s Office of Management and Budget (OMB) on June 15 and June 26, 2026, respectively, for final review. The pharmaceutical industry continues to push back on these models, and it’s possible there will be legal challenges.

Meanwhile, progress has been uneven for the voluntary BALANCE model, under which CMS would negotiate prices for GLP-1 medications on behalf of state Medicaid agencies and Medicare Part D plan sponsors. Following limited participation from Part D sponsors, CMS delayed the Medicare component of the model, originally slated for a 2027 launch. The Medicaid component, however, has stayed on track with state participation applications open through July 31, 2026. In response to the delay of the Part D BALANCE model, CMS announced an extension of the Medicare GLP-1 Bridge Program, which will now run through the end of 2027. Through the Bridge Program, which went live on July 1, eligible beneficiaries will have access to select weight-loss drugs (Foundayo, Wegovy (injection and tablets), and Zepbound) with a $50 copay.

CMS also extended participation deadlines for the GENEROUS Model. Manufacturer applications were due July 17, 2026, while states have until September 10, 2026 to apply to participate in the GENEROUS model, subject to any further extensions.

As CMS continues to expand its Innovation Center portfolio, including the alternative drug pricing models, the agency is reportedly seeking to increase staffing to accommodate the needs of these alternative payment models and other CMS initiatives.

CMS Seeks Input on Medicare Part D CAA 2026 Reform Implementation. As we reported, on June 16, 2026, CMS issued a request for information (RFI), Pharmacy Benefit Manager Compensation and Data Collection, seeking stakeholder input on the implementation of Section 6224 of the Consolidated Appropriations Act, 2026 (CAA 2026). Section 6224 imposes new restrictions on PBM compensation in Medicare Part D and establishes reporting requirements that are slated to take effect on January 1, 2028. Through a series of questions focused on defining PBMs, affiliates, bona fide service fees, fair market value, pharmacy payment arrangements, and data collection, CMS signals a strong interest in identifying and monitoring pharmacy benefit compensation arrangements that may fall outside the statutory bounds. The RFI also suggests that CMS intends to prioritize transparency, closely scrutinize remuneration flowing through affiliated entities and indirect pharmacy benefit arrangements, and develop a robust reporting framework to support future oversight and enforcement in the industry.

For additional background on Section 6224 and the broader PBM reforms enacted by the CAA 2026, see our blog post here

DOL Receives Stakeholder Feedback on Proposed PBM Disclosure Rule Following the CAA 2026. As discussed in our Spring 2026 edition of the PBM Update, the Department of Labor (DOL) issued a proposed rule, Improving Transparency into Pharmacy Benefit Manager Fee Disclosure, earlier this year, aiming to clarify how the ERISA provider disclosure requirements under the Consolidated Appropriations Act, 2021 should apply to PBMs. Just days after the DOL announcement, Congress passed the CAA 2026, which included similar PBM disclosure and transparency requirements. This legislation prompted the DOL to extend the comment period for its proposed rule by 15 days to allow stakeholders additional time to comment in light of the new legislation.

The comment period closed on April 15, 2026, with stakeholders submitting more than 550 comments. As previously discussed, a central theme among commenters concerned the proposed rule’s interaction with the PBM transparency framework of the CAA 2026. Several commenters also questioned the DOL’s authority under ERISA and raised procedural concerns with the rulemaking process pursuant to the Administrative Procedure Act (APA).

OIG: Vertical Integration of Medicare Part D Sponsors and Potential Impact on Drug Costs. On May 19, 2026, amid ongoing concerns about market consolidation and its effect on drug costs and competition, the HHS Office of Inspector General (OIG) posted a report examining the effects of vertical integration and consolidation of Part D sponsors with PBMs and pharmacies, Impacts of Vertical Integration in Medicare Part D on Sponsors’ Drug Costs, Pharmacy Reimbursement, and Enrollee Cost Sharing.

OIG found that although vertically integrated sponsors and nonintegrated sponsors generally achieved similar net drug costs for selected drugs reviewed in the report, these parties generally used different reimbursement strategies in contracting practices. Specifically, OIG noted that while those sponsors that were vertically integrated typically paid pharmacies more upfront, they also recouped more rebates and fees later in the reimbursement process. The report also found that enrollees in plans offered by vertically integrated Part D sponsors generally had lower monthly premium payments, but these enrollees often faced higher out-of-pocket costs when paying for prescription drugs. OIG noted that limitations in available data and ongoing market changes make it difficult to fully assess the impact of vertical integration in the pharmacy benefit space.

State Legislation and Litigation

Recently Enacted State Legislation

Between mid-February 2026 and June 2026, several states enacted legislation imposing new requirements on PBMs across a wide range of regulatory areas. These enactments reflect the continued expansion and refinement of state PBM oversight frameworks, with significant implications for PBMs, pharmacies, health insurers, and other stakeholders in the prescription drug supply chain.

Pending State Legislation

State legislators introduced over 75 bills between mid-February 2026 and June 2026. View our table of pending state PBM legislation by topic.

Legal Challenges to State PBM Laws

Eighth Circuit Finds Arkansas Network Geographic Requirements Preempted by ERISA. In Flowers v. Caremark PCS Health, LLC, the US Court of Appeals for the Eighth Circuit held that certain Arkansas requirements governing PBM pharmacy networks were preempted by ERISA. Specifically, provisions requiring PBMs to maintain pharmacy networks according to certain geographic requirements (e.g., a certain percentage of individuals in a plan residing within a set number of miles of a pharmacy) were determined to encroach upon ERISA by effectively dictating how PBMs structure and manage their networks. (A separate legal decision, which had preliminarily enjoined the Arkansas law based upon the provisions governing pharmacy ownership, is currently under review by the Eighth Circuit.)

PBMs and PCMA Challenge Tennessee’s Fair RX Act; Sixth Circuit Decides McKee Foods Corp. v. BFP, Inc. Tennessee’s recently enacted Fair RX Act, which seeks to limit PBM ownership and control of pharmacies, has become the target of three separate federal lawsuits filed by CVS, Express Scripts, and the Pharmaceutical Care Management Association (PCMA). The plaintiffs argue that the statute is preempted by federal programs, including ERISA, Medicare Part D, and TRICARE, and that requiring PBMs to divest long-standing pharmacy operations constitutes an unconstitutional taking of property. The lawsuits also allege that the law disproportionately burdens large national and specialty pharmacies that are located out of state. (These legal challenges have been brought despite the efforts of Tennessee lawmakers to adjust the Fair RX Act to account for legal issues identified in the prior lawsuits against the Arkansas law, including enacting certain exemptions for federal and military contracts.) These lawsuits remain pending.

Separately, in April, the Sixth Circuit decided in McKee Foods Corp. v. BFP, Inc. that Tennessee’s any-willing-provider and anti-steering rules attempted to govern a matter of plan administration, and thus the regulations were preempted by ERISA.

PCMA Challenges Illinois’ PDAA Reporting and Anti-Steering Requirements. Illinois’ Prescription Drug Affordability Act (PDAA) faces a similar challenge in federal court in Illinois in PCMA v. Gillespie. The PDAA requires PBMs to submit annual reports detailing the PBM’s drug pricing and dispensing practices to the state Department of Insurance and to payor customers. The PDAA also seeks to prevent PBMs from steering patients to pharmacies owed by the PBM and prohibits PBMs from designing networks to favor certain pharmacies. Here, PCMA argues that the state statute is preempted by ERISA.

State PBM Enforcement Actions

Florida Launches Antitrust Investigation of CVS’s Ownership of PBM Caremark. Florida’s attorney general is investigating CVS’s ownership of Caremark along with hundreds of retail pharmacies in Florida. On June 23, 2026, Attorney General James Uthmeier issued a Civil Investigative Demand (CID) probing CVS/Caremark’s practices with respect to patient steering, reimbursement, audits, pharmacy contracts, rebates, and future expansion plans. According to the attorney general, compliance with the CID is required by July 28, 2026 — though it would not be unusual for this deadline to be extended. We have previously written on state and federal legislation targeting vertical integration, and Florida’s investigation is another example of state-level enforcement action focused on the theory that vertically integrated PBM-pharmacy models harm competition and limit choices for consumers.

Discovery to Proceed in Michigan Antitrust Suit Against PBMs Pending Motion to Dismiss. In Michigan v. Express Scripts, Inc. et al., No. 2:25-cv-11215 (E.D. Mich.), the PBMs moved to dismiss an April 2025 complaint filed by the Michigan attorney general. The complaint alleged that Express Scripts and Prime Therapeutics engaged in an unlawful agreement to suppress pharmacy reimbursement rates and harm competition. The PBMs argue that the state’s horizontal price-fixing claims are legally deficient and time-barred. Despite the PBMs’ request that discovery be stayed while the motion is pending, on April 20, 2026, Judge Jonathan J.C. Grey ordered discovery to proceed. This means that, notwithstanding the chance of dismissal, Michigan could obtain internal documents that shed light on how the PBMs set reimbursement rates and negotiate pharmacy contracts.

PBMs Seek Dismissal as Ohio Antitrust Action Proceeds in Federal Court. We previously covered the Sixth Circuit’s decision to keep Ohio’s lawsuit against several PBMs in federal court. Ohio brought the case under state antitrust and deceptive trade practices laws, accusing the PBMs of working together to inflate drug prices. The court found the PBMs were “acting under” federal officers, which allowed the case to stay in federal court.

The PBMs have since moved to dismiss the state’s complaint, arguing that Ohio has not shown a “conspiracy,” an unreasonable restraint of trade, or antitrust injury. The PBMs also argue that Ohio lacks standing — meaning it is not legally authorized — to bring these claims. Ohio opposed the motion, challenging the PBMs’ reliance on federal legal doctrines and defending the strength of its allegations. The parties finished briefing in late June and are now awaiting the judge’s decision. The appellate case is Ohio ex rel. Dave Yost v. Ascent Health Services, LLC et al., No. 24-3033 in the US Court of Appeals for the Sixth Circuit.

State Prescription Drug Boards

Colorado PDAB Litigation Update. In our Spring 2026 PBM Update, we reported on the pending legal challenges to the Colorado PDAB’s upper payment limit (UPL) on prescription drugs (scheduled to take effect on January 1, 2027). On July 1, the US District Court for the District of Colorado granted a preliminary injunction preventing enforcement of the UPL. The court held that the manufacturer was likely to succeed on the merits of its federal patent law challenge.

Update Since Publication: The Colorado PDAB voted to appeal the injunction.

Maryland PDAB Proposed Its First UPLs. The Maryland PDAB proposed rules to implement UPLs on two prescription drugs. If finalized, the rules will be implemented in two phases. Phase 1 will go into effect in January 2027 and will apply to state and local government employee health plans. Phase 2 will go into effect in January 2028 and will expand the UPL to commercial payors.

Virginia Governor Vetoed a Bill to Create a PDAB. Governor Spanberger vetoedH.B. 483 and S.B. 271 (the Affordable Medicine Act). Similar bills were vetoed in 2024 and 2025 by former Governor Glenn Youngkin. The bill would have created a PDAB to conduct data analyses and develop policy recommendations on lowering drug prices. In her veto, the governor focused on the PDAB’s ability to establish UPLs, which, she argues, limit the availability of drugs based on cost, instead of medical necessity. She also asserts that UPLs in other states have not produced savings.

Louisiana Created a PDAB Without Authority to Set UPLs. On June 12, the governor signed S.B. 401, which requires the new PDAB to (1) develop a list of prescription drugs sold in Louisiana for which there is a substantial public interest in understanding pricing, (2) identify up to 10 prescription drugs on which the state spends significant health care dollars and require manufacturers to report on them, and (3) publish a report on the PDAB website of its findings. The Act also requires manufacturers to annually report their current wholesale acquisition cost (WAC) for drugs sold in Louisiana and to report more detailed pricing information on drugs that meet certain price increase thresholds. These manufacturer reports will be published on the Department of Insurance website.

Separately, on June 29, the National Academy for State Health Policy published revised model legislation intended for states that want to use Medicare maximum fair prices as UPLs without establishing a PDAB.

Other Industry News

Insulin Pricing Litigation

Additional Plaintiffs Joined the Insulin MDL. As reported in our Spring 2026 PBM Update, the multi-district litigation (MDL) in the District Court of New Jersey is comprised of over 500 cases spanning plaintiffs from various entities including state and local governments, self-funded payors, unions, and private companies. The claims, combined under the MDL, allege that consumers were deceived by PBMs and manufacturers through a pricing scheme whereby manufacturers conspired to artificially raise prices and paid PBMs secret rebates for placement on the PBMs formularies. Since our last update, the following plaintiffs have joined the MDL or filed suits in their respective states:

• The Commonwealth of Virginia;
• Chester County, Pennsylvania; and
• Aramark Services, Inc.

Opioid Cases Against PBMs

Michigan’s Opioid Suit Against Express Scripts and Optum Rx Remains in Federal Court. On March 31, 2026, a federal judge denied Michigan’s request to remand its lawsuit against PBMs Express Scripts and Optum Rx and their affiliates back to state court, meaning the case will continue in federal court. Michigan sued the two PBMs in state court, alleging that their business practices helped fuel the opioid addiction crisis. Because the PBMs handle drug benefits for federal workers and the US Department of Defense as well as for private clients, the judge found they were acting under federal direction, and that their federal and nonfederal work could not be separated. Michigan tried to keep the case in state court by carving out the work done for federal clients, but the federal judge agreed with the companies that their negotiations on behalf of all clients are too intertwined to divide.

On May 15, 2026, the PBMs moved to dismiss the case, arguing they are not to blame for opioid abuse because they have no control over prescription drugs once those medications reach patients. The companies said their role is limited to negotiating drug prices and deciding which medications insurance will cover, and that they cannot be held responsible simply for being part of the supply chain for a legal, heavily regulated product. Citing the decision by the First Circuit Court of Appeals in a similar case earlier this year (discussed in our Spring 2026 PBM Update), the PBMs also contended that the state waited too long to sue, arguing the case is barred by a three-year statute of limitations because Michigan should have known of its claims back in 2019. Finally, the PBMs argued the lawsuit must additionally be dismissed on the grounds that federal law (ERISA) preempts the state’s claims.

Separately, Optum Rx and its parent company, UnitedHealth Group, asked to be dropped from the case, saying the court has no authority over them because they are not based in Michigan. We are tracking additional court activity related to these motions.

Philadelphia Defends Opioid Suit Against CVS and Other PBMs. On February 24, 2026, the City of Philadelphia urged a Pennsylvania federal judge to reject arguments from CVS and other PBMs that they should be released from the city’s lawsuit accusing them of helping fuel the opioid crisis. Responding to the PBM-defendants’ motion to dismiss, the city argued that its claims were both filed on time and strong enough to move forward, contending that the PBMs worked with drug manufacturers to flood the market with opioids and expand access to the drugs in exchange for financial rewards, rather than protecting the health plans and patients who relied on them. As noted in our Spring 2026 PBM Update, the companies had argued the city waited too long to sue; in this pleading, Philadelphia countered that it did not learn the PBMs were a source of its harm until 2022 because of their alleged secret collusion, keeping the 2025 suit within the four-year filing deadline.

The city also defended the substance of its claims, asserting that it spent heavily on public services to fight the epidemic, including purchasing the overdose-reversal drug naloxone, while suffering falling property values, lost tax revenue, and a shrinking population. Philadelphia maintained that the opioid crisis harmed the community as a whole and not just individual users, pointing to widespread effects such as increased crime, discarded needles, and other public health and safety dangers that reach even residents who never used opioids.

Fourth Circuit Holds Express Scripts Entitled to Jury Trial in West Virginia Opioid Abatement Suit. On May 15, 2026, the US Court of Appeals for the Fourth Circuit ruled that Express Scripts is entitled to a jury trial in a lawsuit brought by 120 cities, towns, and counties across West Virginia alleging that Express Scripts contributed to excess opioids in these areas. These local governments had asked for an “abatement fund” to pay for removing the excess opioids as well as for addiction treatment, public education, and community rehabilitation. The trial court had planned to decide those claims itself in a bench trial rather than before a jury. The Fourth Circuit disagreed, concluding that because part of the relief sought (the abatement fund) is a legal remedy and not an equitable one, the Seventh Amendment guarantees the right to a jury.

Express Scripts had separately argued the district court’s order for “statewide” abatement was inappropriately broad because it risked adjudicating the rights of communities that were not parties to the litigation. Although the Fourth Circuit declined to order relief on this issue, the court expressly recognized Express Scripts’ ability to later challenge any order the district court may issue that is overbroad in this respect.

Market Developments

PBM Litigation Trends: The Fight Over Value in the Drug Supply Chain. Recent PBM litigation centers on a common theme: lack of transparency. These cases characterize PBMs not merely as intermediaries, but as gatekeepers whose complex pricing structures allegedly shift costs to plan sponsors, patients, and pharmacies. For example, labor unions are suing PBMs for alleged pricing and rebate schemes that inflate drug costs. In two class actions — one in Illinois against Express Scripts and one in Rhode Island against CVS — plaintiffs allege that PBMs charge drug manufacturers “exorbitant” fees to secure favorable formulary placement. This raises the concern that formulary access may be driven by rebate economics rather than patient cost or clinical value. The cases, brought under the Racketeer Influenced and Corrupt Organizations (RICO) Act, accuse PBMs of diverting billions in drug manufacturer rebates to offshore entities, breaching fiduciary duties, and inflating the costs of life-saving medications. Plumbers’ Welfare Fund, Local 130 U.A. v. Express Scripts et al., No. 1:26-cv-01718 (N.D. Ill.); Roofers’ Unions Welfare Trust Fund v. CaremarkPCS Health LLC et al., No. 1:26-cv-00162 (D.R.I.).

Direct-to-Employer Platforms Emerge as Alternatives to Traditional PBM-Managed Benefits. In early-to-mid 2026, several companies launched pharmacy benefit platforms that allow employers to offer workers access to high-cost drugs without routing those benefits through a traditional PBM. Rising GLP-1 costs and coverage gaps drove this trend. Multiple platforms now enable employers to offer transparent, cash-pay or subsidized pricing arrangements that operate alongside — not within — their traditional pharmacy benefits.

• In February 2026, GoodRx launched “Employer Direct,” a platform that enables employers to select high-impact brand medications (with an initial focus on GLP-1s) and directly subsidize manufacturer-sponsored cash-pay prices available through GoodRx. The employer’s contribution is applied at the pharmacy counter, reducing the employee’s out-of-pocket cost without adding the medication to the insurance formulary.
• In March 2026, Eli Lilly formally launched “Employer Connect,” a direct-to-employer platform offering Zepbound at a list price of $449 per month (applicable to all doses) through a dedicated pharmacy network that includes HealthDyne and Humana’s CenterWell. The platform pairs employers with more than 15 independent program administrators — including Calibrate Health, Teladoc Health, GoodRx, and Mark Cuban’s Cost Plus Drugs — to structure obesity benefits outside traditional plan designs.
• Omada Health also entered this space, offering a GLP-1 cash-pay option for employers that integrates clinical prescribing, behavioral support, and medication fulfillment.

These direct-to-employer models reflect several converging pressures: employer demand for more predictable and transparent pricing from PBMs; employee demand for GLP-1 access; manufacturers’ desire to reach patients who lack formulary coverage; and a broader market shift toward transparency and consumer choice in pharmacy benefits.

Optum Rx Unveils Transparent, Fee-Based Pharmacy Care Model. On May 11, 2026, Optum Rx announced a new pharmacy care model described as the industry’s first fully transparent pricing structure. As noted in our Spring 2026 PBM Update, Optum Rx previously announced a shift to cost-based pharmacy reimbursement and reduced prior authorization requirements. The new model goes further — it replaces traditional pricing approaches tied to manufacturer list prices or prescription volume with monthly, clearly defined per-member fees that are independent of drug pricing. The model also eliminates spread pricing and provides full transparency into Optum Rx’s fees, including those charged by its group purchasing arm, and discloses all payments received from drug manufacturers. By the end of 2027, Optum Rx plans to fully transition its group purchasing to flat service fees.

Optum Rx’s announcement follows similar commitments from competitors. As noted in our Spring 2026 PBM Update, Express Scripts announced a shift to a rebate-free, pass-through model (to be standard for all clients by 2028), and CVS has signaled movement toward cost-plus pharmacy reimbursement. Each of the Big Three PBMs has now announced pricing models that emphasize transparency, though the scope and timing of implementation vary.

PCMA’s Path to Patient Affordability. On June 9, 2026, PCMA released “The Path to Patient Affordability,” a six-part policy platform urging federal and state policymakers to take action to lower drug costs. The platform focuses on competition-enhancing policies, including encouraging prescribers to use electronic tools showing patients their lowest-cost options, accelerating biosimilar adoption, and promoting transparency in manufacturer pricing. PCMA has framed the initiative as building on the PBM reform enacted in the CAA 2026, positioning the industry as aligned with — rather than resistant to — reform objectives.