A Turning Point in the Pharmacy Landscape: What Employer Plan Sponsors Need to Know

By Erin Powell, RHU® | Seubert Compliance Officer

Employer plan sponsors are facing a fundamental shift in the pharmacy benefits landscape driven by two major developments:

The FTC / Express Scripts settlement, and
The PBM reform provisions in the Consolidated Appropriations Act of 2026 (CAA 2026).

Together, these changes significantly expand transparency, accountability, and fiduciary risk for employer-sponsored group health plans.

FTC / Express Scripts Settlement: Enforcement Has Arrived

The FTC’s settlement with Express Scripts signals a clear message:
PBM practices are no longer just contractual issues—they are regulatory risks.

Key implications for employer plan sponsors:

PBMs must substantiate pricing and reimbursement practices
Certain steering and exclusionary behaviors are under heightened scrutiny
The FTC has established a roadmap for future PBM enforcement actions

While the settlement applies directly to the PBM, employer plans that adopt or tolerate opaque PBM arrangements may face increased fiduciary exposure.

For more information about FTC/Express Scripts settlement click here.

CAA of 2026: PBM Reform Becomes Mandatory

The CAA of 2026 codifies PBM reform into federal law, imposing new statutory obligations on group health plans, including:

Expanded PBM compensation and fee disclosures
Enhanced drug cost transparency
New PBM reporting and notice requirements
Stronger alignment with ERISA fiduciary standards

Unlike prior transparency rules, these requirements are not optional and cannot be delegated away.

Under ERISA, employer plan sponsors remain responsible—even when vendors perform the reporting.

For more information about CAA of 2026 PBM Reform click here.

For a comparison between both the FTC Settlement and CAA of 2026 PBM Reform click here.

Reach out to Seubert today to begin renegotiating your pharmacy contract, ensuring complete transparency and unlocking maximum savings.

Erin is the Compliance Officer in Seubert’s Employee Benefits Department. She joined Seubert in 2008 and has more than 17 years of experience in the employee benefits and compliance industry. In her current role, Erin is responsible for ensuring awareness of new developments and/or changes in the various federal and state laws that may impact a business’ employee benefits program.

Compliance

Employee Benefits

Recent News

6 HR Trends for 2026

The workplace is undergoing a transformation, largely driven by technological advancements, regulatory shifts, and evolving employee expectations.

Employee Spotlight: Colin Quirk

Please join us in welcoming Colin Quirk to Seubert’s Commercial Lines Division as an Account Executive based out of our Pittsburgh Office!

Cumulative Trauma Injuries and Workers’ Compensation

Although common in the construction industry, cumulative trauma injuries (CTIs) are some of the most complex workers’ compensation claims.

U.S. News & World Report Reveals Top 2026 Health Trends

This year, U.S. News & World Report replaced its long-running Best Diets annual rankings with a Top Health and Nutrition Trends report.

Fatigue Risks in Cold Conditions

Cold weather does more than make working conditions uncomfortable; it can also lead to fatigue and reduced alertness and responsiveness in employees, increasing the risk of injury.

4 Components of Cyber Risk Management

If your company stores information digitally, it’s important to develop a cyber risk management program that will help minimize the likelihood of a data breach and reduce potential losses if a breach does occur.