New rules give employers and plan fiduciaries greater visibility into healthcare costs and PBM compensation, along with the information needed to evaluate whether vendor prices are reasonable
NEW YORK–(BUSINESS WIRE)–#BenefitsAdministration—Judi Health™, the enterprise health technology company and benefits administrator, today announced its support of the U.S. Department of Labor (DOL) and the Trump Administration in advancing new health plan and pharmacy benefit manager (PBM) transparency requirements. The new rules are designed to shift the balance of power to the buyer by requiring access to healthcare prices and what PBMs and other vendors charge for their services.
The Transparency in Coverage rule aims to bring healthcare prices into the open through machine- and human-readable formats, helping employers and consumers better understand what their care costs. The DOL’s final Improving Transparency into Pharmacy Benefit Manager Fee Disclosure rule also requires PBMs and other vendors to the plan to clearly report their direct and indirect compensation, including any rebates, clawbacks, and other fees associated with dispensing prescription drugs and providing care to plan members.
“Taken together, the recent push by the DOL, the Department of Health and Human Services, and the Department of the Treasury represents a meaningful step toward eliminating the information gaps between health plans and the organizations they hire to administer and provide benefits to plan members,” said AJ Loiacono, Chief Executive Officer of Judi Health. “We’ve always advocated for the separation of administrative services from the prices of drugs and other care, and we built Judi® with the level of transparency that the DOL is pursuing. Since inception, we’ve helped push the industry in that direction to the point where things are finally changing.”
The new rules and requirements give employers access to more complete information, down to the claim level. They will help plan fiduciaries evaluate vendor compensation, negotiate more effectively, and determine whether the prices their plans pay are reasonable.
“We applaud the Department of Labor for recognizing that employers cannot effectively manage healthcare costs without access to clear, complete, and usable price information,” said Lloyd Fiorini, Judi Health’s General Counsel and Chief Compliance Officer.
Complete disclosure during the request for proposal process is particularly important because fiduciaries must ensure that the services and compensation included in their health plan contracts are reasonable. “Without adequate, accurate information, plan sponsors can face prohibited transaction and fiduciary risks under ERISA,” added Fiorini.
Giving Plan Fiduciaries the Information They Need
Under the Consolidated Appropriations Act of 2021, vendors performing substantive activities for health plans have been expected to disclose direct and indirect compensation under Section 408(b)(2). However, many large vendors have maintained that the requirement does not apply to them. The Consolidated Appropriations Act of 2026 and new DOL rules seek to remove that ambiguity by establishing an enhanced disclosure framework for PBMs and other covered service providers.
The disclosures will help fiduciaries identify forms of compensation related to plan member claims processing that are otherwise difficult or impossible to see. Without information related to the actual cost of drugs, rebates, and other fees impacting the total cost of care, plan sponsors are unable to determine the PBM’s or service providers’ total compensation – or independently evaluate whether it is reasonable.
For too long, plan fiduciaries have had to expend significant time and resources to obtain basic information about rebates, manufacturer fees, and other sources of vendor compensation. The new DOL rules give everyone operating a health plan the ability and tools to understand what they are paying, benchmark costs, and make more informed purchasing decisions.
Transparency Must Extend Beyond Pharmacy Benefits
The DOL’s rules recognize that plan fiduciaries deserve transparency in all aspects of their contracting. Prescription drugs administered through the medical benefit represent a significant area of plan spending, and incomplete medical-benefit disclosures could allow opaque fees or pricing arrangements to persist outside the pharmacy benefit.
The federal actions complement Judi Health’s efforts – since inception – to strengthen PBM accountability and promote the integration of benefits through the deployment of modern enterprise health technology: Judi.
Clarifying PBM and other vendor disclosure responsibilities under ERISA can reinforce those efforts and help establish consistent expectations that health plan vendors will disclose how they are compensated.
“Employers should not have to fight for the fundamental information required to manage their own benefit plans,” Loiacono added. “We commend the Administration and the Department of Labor for advancing rules that place better information in the hands of plan fiduciaries. This is a critical step toward a healthcare market where price transparency supports competition, accountability, and a focus on what matters most: patient care.”
About Judi Health™
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry’s first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we’re deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefit plans for millions of Americans and proudly leading the next generation of care. To learn more, visit Judi Health.
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