With Election Day rapidly approaching, President Donald Trump has once again demonstrated his unwavering commitment to the American people, delivering a significant win for healthcare transparency that exposes the dark dealings of prescription drug middlemen. This is not just a policy change; it’s a direct strike against the entrenched interests that have long profited from opacity at the expense of hardworking Americans and their employers.
On October 29, Trump’s Labor Department finalized a pivotal rule requiring Pharmacy Benefit Managers (PBMs) to fully disclose compensation to large employers with self-insured health plans – those covering at least 100 participants. For too long, these businesses, which shoulder the burden of their workers’ health claims, have been denied a clear accounting from the very companies managing their prescription benefits. As Labor Secretary Keith Sonderling aptly put it, "PBMs have operated in the shadows, pocketing hidden fees while workers and employers were left in the dark."
This critical reform targets insidious practices like "spread pricing," where a PBM charges a health plan more for a drug than it pays the pharmacy, pocketing the difference. The new rule demands transparency on this compensation, along with manufacturer rebates and any money recouped from pharmacies. Crucially, it empowers employers with the right to audit these disclosures, implementing much-needed reforms Congress passed in the Consolidated Appropriations Act, 2026. This is accountability in action.
Utah Treasurer Marlo Oaks praised President Trump’s decisive action, emphasizing the real-world impact on American pockets. "President Trump is once again delivering on his promise to bring real transparency and accountability to healthcare," Oaks stated. "His administration deserves tremendous credit for putting American employers and workers first. By exposing hidden costs and empowering businesses to save money, this rule is a major win for workers, taxpayers, and retirees."
Echoing this sentiment, Utah Auditor Tina Cannon welcomed the change, though she correctly pointed to the next frontier in the fight for transparency. "The Department of Labor should now build on that progress by extending these same transparency requirements to third-party administrators," Cannon urged, "ensuring employers have the complete picture of where their healthcare dollars are going. State financial officers like me are taking notice and will use this information to demand greater accountability and to protect the retirements and pensions of our constituents."
The administration projects a staggering $22 billion in lower prescription spending over a decade – a testament to the potential power of sunlight on corporate practices. While securing these savings will require diligent employers to scrutinize the new disclosures and leverage them in negotiations with PBMs, the framework for genuine cost reduction is now firmly in place.
Despite the rule’s effective date in January 2027 and its application to plan years beginning on or after July 1, 2027, President Trump ensured this vital reform was finalized before the upcoming election. This strategic move cements a victory for common sense and positions Republicans to campaign on tangible results for American families and businesses, regardless of the left’s predictable attempts to downplay its significance.
Nebraska Auditor Mike Foley also lauded the President, highlighting the broader fiduciary responsibility. "I thank President Trump and his administration for giving employers the light to see what they’re actually spending each year and the power to negotiate changes," Foley affirmed. "For companies in which the pensions of state employees like teachers and police officers are invested, helping them examine healthcare overspending is very much our shared fiduciary duty."
While groups like the ERISA Industry Committee and the National Community Pharmacists Association have rightly applauded the decision, the PBM trade group, Pharmaceutical Care Management Association, through its head David Marin, predictably objects. Marin labels the rule redundant and warns of potential harm to smaller PBMs, claiming less competition and higher costs. This, of course, comes from an industry whose three biggest players — UnitedHealth’s Optum Rx, CVS’s Caremark, and Cigna’s Express Scripts — control an astounding 80 percent of U.S. prescriptions. Perhaps more transparency is precisely what those dominant players fear.
Ultimately, employers can now weigh these self-serving warnings against the hard numbers they will soon uncover in their own contracts. Tina Cannon’s call to expand transparency to third-party administrators is a logical next step in an ongoing battle, but for now, the PBMs know the game has changed. Every future negotiation will be a vastly different, and hopefully much fairer, conversation thanks to President Trump’s bold action. This is the America First agenda delivering true accountability and putting the power back where it belongs: with the American people.
