Washington, D.C. February 3, 2026– The ERISA Industry Committee (ERIC) today praised passage of the Consolidated Appropriations Act of 2026 (the CAA) as a victory for the more than 160 million workers and families who receive their coverage through the employer-based system. ERIC has long been an outspoken advocate on these provisions because they increase transparency and accountability and have an impact on affordability for employers and workers.
Specifically, the CAA includes several reforms to the pharmacy benefit manager (PBM) industry that represent a major step forward for meaningful health care reform. The PBM provisions included in the final legislation help shine a light on PBM business practices, promote transparency, and ensure that negotiated savings benefit plan sponsors and patients – not middlemen.
“For years, ERIC has carried the proverbial PBM policy football down the field. Some years, we gained yards. Other years, it was more like Lucy with the football in that old Charlie Brown cartoon. ERIC would get the ball down the field and be ready to kick it through the goal post for the win, only to have it yanked away at the last second,” said James Gelfand, President and CEO of ERIC. “Now, after eight years, ERIC-led reforms to the PBM industry that instill greater accountability and transparency made it across the goal line, and the result will be lower drug costs for more than 160 million Americans who get their health insurance through a job.”
The reforms secured in the CAA are the result of broad collaboration among diverse stakeholders. Large employers, small employers, community pharmacists, patient and disease advocacy groups, transparent PBM allies, and stakeholders across America all joined forces to advocate for changes aimed at improving accountability, affordability and transparency from the PBM industry, which for too long operated with little to no oversight.
Additionally, the provisions included a requirement for “honest billing” transparency in Medicare, requiring off-campus hospital outpatient departments to bill using unique National Provider Identifiers (NPIs). This reform will enable carriers to use NPI data to determine whether care took place at a hospital or not, and to ensure that billing reflects this – wiping out inappropriate facility fees, pushing back on upcoding, and curbing the disastrous health system consolidation trend.
Gelfand added, “We applaud the bipartisan leadership in Congress that recognized the importance of addressing health care affordability. Remaining determined and continually listening to employers, workers, and patients alike, Congress demonstrated a clear commitment to doing what is right for patients and employers – and they didn’t back down despite significant pressure from the health care industry. We are grateful for their efforts and the work they’ve done alongside the Trump administration to deliver a victory for all stakeholders who will see it where it counts – in their pocketbooks.”
Provisions championed by ERIC that were in the final version of the bill include:
- Sec. 6701. PBM Reporting to Group Health Plan Sponsors – Requires semi-annual reports on spending in prescription drug benefits, detailing prices, rebates, fees, alternative discounts, spread pricing arrangements, and the rationale for higher-cost drugs receiving favorable treatment over lower-cost alternatives on drug formularies.
- Sec. 6702. Full Rebate Pass-Through for Employers – Mandates PBMs (and affiliates such as Group Purchasing Organizations) remit 100 percent of rebates and remuneration from pharmaceutical manufacturers to employers or sponsors; allows flat administrative fees; provides fiduciary liability protection with reasonable compliance steps.
- Sec. 6224. Delinking PBM Compensation from Drug Prices (Medicare Part D) – Prohibits compensation tied to drugs’ list prices; requires flat fees or price-neutral arrangements; establishes transparency, reporting, and audit rights.
- Sec. 6225. Requiring hospital outpatient facilities to use a unique National Patient Identifier – Requires off-campus hospital outpatient departments to use a unique National Provider Identifier when billing Medicare.