State Financial Officers Back Trump DOL Rule Targeting PBM and Insurer Pricing Secrecy

More than a dozen state financial officers have publicly backed a recent Department of Labor rule, promulgated during the Trump administration, that tightens disclosure and oversight requirements for pharmacy benefit managers (PBMs) and insurers in employer-sponsored health plans. The officials argue the rule clarifies fiduciary duties for plan sponsors and requires greater transparency around PBM compensation, rebate pass‑throughs and pricing arrangements so plan fiduciaries can detect fraud, waste and conflicts of interest that inflate costs for employers and beneficiaries.

Supporters point to the larger context behind the move: U.S. health care loses an estimated $1.6 trillion a year to waste, inefficiency and fraud, and federal enforcement actions remain substantial — civil False Claims Act recoveries topped $1.8 billion in fiscal 2023 alone. Advocates highlight practices such as PBM spread pricing, where middlemen bill plans more than they reimburse pharmacies, as a mechanism that hides costs and frustrates audits. On social media, proponents framed the effort as defining fiduciary duty and pushing PBM accountability (@TheRealNickPace, @USCSchaeffer), patient-advocacy groups urged stronger fee-disclosure and enforcement for specialty medications (@CSROAdvocacy), industry observers hailed bipartisan momentum for cracking down on middlemen (@PhRMA), and watchdog accounts have amplified allegations that rebates and fees are sometimes funneled through opaque entities to evade pass-through rules (@og_stokes).

Coverage of PBMs and pricing secrecy has shifted in recent years from largely accepting PBMs as back‑office negotiators to treating their practices as a regulatory and fiduciary problem. Early reporting often emphasized rebate-driven savings and the complexity of drug supply chains; more recent stories, driven by state investigations, legislative changes and enforcement actions, have foregrounded spread pricing, rebate diversion and the need for independent audits. That evolution is reflected in both the growing number of state financial officers pressing the DOL and in outlets amplifying those views — a shift that helped propel the rule into the spotlight and reframed transparency as central to reducing waste and protecting plan beneficiaries.