The Department of Labor recently published a proposed rule that would require pharmacy benefit managers (PBMs) to disclose how they're compensated when managing prescription drug benefits for employer health plans. This is a significant step toward the kind of price transparency that we have long needed.
Trek Health submitted formal comments on the rule during the public comment period. As the proposed legislation directly impacts future payer compliance, the structural choices made in the final rule will determine what health systems can actually do with the data. Trek is working to not only surface what payer data reveals about the current landscape, but proactively engage in the process to ensure the policy infrastructure underlying that data is built to be usable from the start. Here's what we said and why it matters.
Why We're Commenting
PBMs sit between drug manufacturers, pharmacies, and health plans. They negotiate drug prices, design formularies, and process claims — and they're often compensated in ways that aren't visible to the plan sponsors paying the bills. Spread pricing, rebate arrangements, and administrative fees can all affect what a plan actually pays for drugs, but today most plans have no reliable way to see those figures clearly.
The DOL's proposed rule would change that by requiring PBMs to produce structured disclosures, including machine-readable files, that plan fiduciaries can use to evaluate whether their PBM arrangements are actually working in their favor.
At Trek, we work with machine-readable file data every day to help health systems understand what they're being paid and by whom. So when the DOL proposed a rule that depends on that data being structured and usable, we had specific things to say about how to get it right.
What We Said About the MRF Provisions
Our comments focused on three technical issues with the machine-readable file requirements that, if left unaddressed, could undermine the rule's transparency goals.
1. "Reasonable time" needs a defined limit.
The rule requires PBMs to produce their disclosure files "within a reasonable time" after a plan requests them — but it doesn't define what that means. Without a specific deadline, a PBM could respond weeks later with a file that reflects compensation from a prior period, not the current one. A plan trying to evaluate whether their contract is working can't do that with stale data. We recommended tying the response deadline to the most recent semiannual disclosure period, with a 30-day outer limit from the date of request.
2. "Machine-readable" isn't specific enough.
The rule defines a machine-readable file as one that "can be imported or read by a computer system without human intervention." Technically, that's accurate — but it's broad enough that PBMs could produce files in proprietary formats with inconsistent structures that are nearly impossible to compare across plans or contracts without significant technical work. We've seen this problem play out in the Transparency in Coverage rollout, where schema variation across health insurers created real barriers for anyone trying to do systematic analysis. We recommended the Department publish a minimum field-level schema alongside the final rule, so that disclosures are designed to be interoperable from the start.
3. NDC granularity matters.
The rule requires drugs to be identified using a National Drug Code (NDC) — but NDCs come in three levels of specificity: a 5-digit labeler code, a 9-digit product code, and an 11-digit package code. Reporting at a higher level of aggregation masks meaningful variation across manufacturers and package sizes, which is exactly the kind of variation that reveals spread between what a PBM pays for a drug and what it charges the plan. We recommended the rule specify the 11-digit NDC as the minimum, which is already the standard used in pharmacy claims adjudication.
The Bottom Line
The DOL's proposed rule is an important move toward real PBM transparency. Getting the technical details right — on timeliness, file structure, and identifier granularity — is what determines whether the data it requires will actually be usable in practice. We're committed to staying engaged at the policy level to make sure the infrastructure for transparency is built on a foundation that works.
