March 2026 Edition
Welcome to The Legislative Dose, SlateRx’s regular briefing on the ever-evolving world of pharmacy benefits legislation. This brief report will provide insights and updates on policies, regulations, reforms, and trends shaping the pharmacy benefits space that impact plan sponsors and patients alike. We hope you consider this a concise, reliable resource for staying informed and prepared in a shifting legislative landscape.
Legislative Shifts to Watch
The pharmacy benefits landscape is entering a period of accelerated change, with federal actions signaling a clear shift toward greater transparency, accountability, and scrutiny of how prescription drug benefits are designed and managed. In this issue of The Legislative Dose, we focus on the big shifts taking shape and what they signal about the future direction of the market. While many of these developments will unfold over time, they collectively point toward increased oversight of PBMs, evolving expectations for plan fiduciaries, and potential changes to contracting, reporting, and cost management strategies, making it critical for plan sponsors to monitor these trends closely and understand how they could affect plan performance, compliance obligations, and long-term sustainability.
Federal Trade Commission’s Settlement with Express Scripts
Status: Settled February 4, 2026
Summary: The Federal Trade Commission (FTC) settled a lawsuit with Express Scripts (ESI) alleging that they artificially inflated the list price of insulin drugs and steered utilization toward higher-rebate drugs. The settlement requires Express Scripts to adopt a number of changes that increase transparency and access to lower cost drugs.
What it could mean for your plan: While the settlement applies specifically to Express Scripts, it reflects growing federal scrutiny of rebate-driven pricing practices across the PBM industry and may influence formulary strategies, contracting terms, and transparency expectations more broadly. Ultimately, it’s too soon to tell the full impact of this landmark settlement.
Consolidated Appropriations Act, 2026 (H.R. 7148/CAA 2026)
Status: Signed February 3, 2026 – now entering multi-year implementation process
Summary: The Consolidated Appropriations Act includes sweeping PBM reforms. The law affects Medicare Part D, Medicare Advantage Plans, and Commercial group health plans. Key provisions move the industry toward 100% rebate pass-through (beginning in 2028), standardized plan-level reporting and transparency requirements, enhanced federal oversight, and treating certain PBM noncompliance as a prohibited transaction under ERISA.
What it could mean for your plan: CAA 2026 strengthens transparency requirements and weakens rebate-driven economics, but actual savings will depend heavily on a plan’s PBM contract, and most changes will phase in over several years. Even though implementation is gradual, the law signals a structural shift in how PBMs will be compensated and monitored, making it important for plan sponsors to consider how contracts signed today will perform under future regulatory requirements.
Department of Labor PBM Fee Disclosure Rule
California – SB 41 (Pending)
Status: Pending – The DOL has issued a Notice of Proposed Rulemaking, and stakeholders may submit feedback during the public comment period.
Summary: Separate but complementary to CAA 2026, the Department of Labor’s proposed PBM Fee Disclosure Rule is a package of regulations and guidance focused on compensation disclosure, conflicts of interest, and fiduciary accountability for PBMs serving ERISA-governed employer health plans. The proposal would establish a clearer ERISA compliance framework, make PBM compensation directly reviewable by plan fiduciaries, require detailed fee and compensation disclosures, and help implement PBM reforms enacted in recent federal laws, including CAA 2026.
What it could mean for your plan: Once finalized, the DOL PBM Rule could represent one of the most consequential ERISA changes to pharmacy benefits in decades, reinforcing expectations that plan sponsors understand and evaluate how their PBM is compensated. Although enforcement is still years away, the proposal signals a clear shift toward fiduciary-level transparency and oversight, making it important for plan sponsors to assess whether current contracts provide visibility into pricing, fees, and potential conflicts of interest.
TrumpRx Direct-to-Consumer Drug Platform
Status: Launched February 5, 2026
Summary: The Trump administration launched TrumpRx, an online platform designed to help cash-paying patients purchase prescription drugs at discounted prices. The site does not sell medications directly but instead directs users to manufacturer-sponsored direct-to-consumer (DTC) programs, participating pharmacies, or printable coupons offering discounts off list prices. While advertised prices may be substantially lower than list prices, insured patients may still pay less through traditional copays. Purchases made through TrumpRx currently do not count toward deductibles or out-of-pocket maximums. The platform initially listed 43 drugs from manufacturers participating in the administration’s most-favored-nation (MFN) pricing initiative, with additional products expected to be added.
What it could mean for your plan: TrumpRx represents a growing push toward direct-to-consumer drug purchasing models that operate outside traditional insurance channels. While the program is aimed at uninsured or underinsured patients, it could influence member behavior, pharmacy utilization patterns, and perceptions of drug pricing transparency. For plan sponsors, the key issue to watch first is whether cash-pay alternatives begin to cause confusion about coverage, accumulators, and true out-of-pocket costs.
Our Take
Together, these developments point to a pharmacy benefits environment that is moving toward greater transparency, accountability, and scrutiny, but also increased complexity for plan sponsors. While most changes will unfold over several years, the direction is clear: oversight is tightening, expectations for fiduciary diligence are rising, and the structure of PBM contracting and drug purchasing is evolving in ways that could materially affect plan performance.
SlateRx is proactively monitoring these developments and will continue to distill their implications into timely, actionable insights so our clients can make informed decisions. As legislative and regulatory changes continue across the market, SlateRx’s model is well positioned to navigate this evolving landscape on behalf of our clients, helping ensure they remain compliant and protected from unnecessary risk.
If you would like to discuss these changes or evaluate whether your current strategy is positioned for what lies ahead, please reach out to us. We’re happy to help.
