Short answer: Today it depends on the PBM contract. Under the Consolidated Appropriations Act, 2026, for contracts entered into or renewed for plan years beginning on or after August 3, 2028, a PBM must remit 100% of rebates, fees and other drug-related remuneration to the group health plan quarterly, with records open to audit at least once per plan year.
New ERISA section 408(b)(2)(C) says a PBM contract is not reasonable, which would make it a prohibited transaction for the plan, unless the PBM remits 100% of rebates, fees, alternative discounts and other remuneration from manufacturers and similar entities tied to the plan’s drug use. Remittance is quarterly, no later than 90 days after each quarter ends, and amounts must be fully disclosed and enumerated.
The plan, or a third party it designates, may audit those records at least once per plan year and may audit the rebate contracts with aggregators or manufacturers. The auditor is selected by the responsible plan fiduciary and cannot be paid, directly or indirectly, by the PBM. Rebate aggregators must pay the PBM within 45 days after each quarter.
The rule applies to plan years beginning on or after 30 months after February 3, 2026, for contracts entered into, renewed or extended on or after that date. PBMs may still charge transparent, quantifiable bona fide service fees. Until then, negotiate rebate guarantees, definitions and audit rights in the contract.