Big News: CMS Targets PBM Transparency – A Win for Injured Workers?

If Pharmacy Benefit Managers (PBMs) don’t change how they operate, the federal government is finally ready to act—especially when it comes to the billions in kickbacks and hidden rebates they receive on prescription drugs.

This is a huge step forward in the fight for fair pricing and patient-first care. And yes, we still need your help to defeat SB306 if it comes back next year.

The Push for Transparency Is Gaining Momentum

Health Care Drive online article – June 24, 2025

As prescription drug prices continue to skyrocket, momentum is building in Washington for long-overdue reform. Now, the Centers for Medicare & Medicaid Services (CMS) is preparing a rule that would require greater transparency from PBMs and health insurance companies about how they price and reimburse medications.

At a recent press event, CMS Administrator Dr. Mehmet Oz confirmed a rule may be released before the end of the year:

“We’ll be able to very forcefully go after folks who are not transparently sharing what it actually costs—or what the transaction prices were for the drugs that Americans are trying to pick up,” Oz said.

This initiative follows previous efforts under the Trump administration to bring accountability to an industry that’s been hidden behind contracts, middlemen, and legal loopholes.

What’s at Stake: Profits, Patients, and Transparency

PBMs like CVS Caremark, Express Scripts (Cigna), and Optum Rx (UnitedHealth) manage the majority of U.S. prescriptions. However, critics say these companies:

• Operate behind closed doors

• Keep rebates secret

• Drive up costs for patients and employers

• Make it harder for independent providers to participate

For pharmacies like RescueMeds, the lack of transparency creates real challenges. We’re forced to compete without knowing the negotiated prices or the rebate arrangements between PBMs and big insurers.

Why This New Rule Matters

If enacted, the proposed CMS rule would:

• Require PBMs to report actual drug prices and rebate amounts

• Shine a light on how much money PBMs keep vs. pass along

• Allow employers, unions, and doctors to make more informed decisions

• Open the door for smaller, patient-focused pharmacies to compete fairly

This could finally bring real accountability to drug pricing—and help injured workers get faster, more affordable care.

But There Are Roadblocks…

Not surprisingly, PBM lobbyists are pushing back hard.

The Pharmaceutical Care Management Association (PCMA) has previously sued to block transparency rules. They argue that public disclosure would hurt their bargaining power and cause manufacturers to reduce rebate offers.

In response, the Biden administration initially scaled back transparency—limiting PBM disclosures to federal agencies only. But that may soon change.

In May, the Departments of Health and Human Services (HHS), Labor, and Treasury issued a new Request for Information (RFI) asking how to expand pricing disclosures and improve enforcement.

Their message was clear:

“Making more cost information widely and easily available will ultimately foster a more competitive, innovative, affordable, and higher quality healthcare system.”

How This Affects Workers’ Comp and RescueMeds

For injured workers and providers in the workers’ compensation system, this is more than policy—it’s survival.

PBMs often deny, delay, or restrict prescriptions for claimants, especially from pharmacies that aren’t under contract with them. This makes it harder for providers like RescueMeds to get medications to injured workers quickly—and fairly.

With better transparency, we can:

• Show how much PBMs really pay—and keep

• Hold insurers and PBMs accountable

• Help employers and unions choose value-based pharmacy partners

• Ensure injured workers get the medications they need—without unnecessary barriers

The Bottom Line

Whether you’re:

• An injured worker,

• A union representative,

• A doctor,

• Or an attorney fighting for your clients…

Price transparency affects YOU.

At RescueMeds, we continue to fight for fairness—for patients, for providers, and for the future of workers’ comp pharmacy. If CMS follows through on this rule, it could be the first major step toward a more transparent, competitive, and patient-focused drug system.