House negotiators have put two major pharmacy benefit manager provisions in big, “must pass” spending package that’s now speeding toward a vote on the House floor.
One provision in the Consolidated Appropriations Act, 2026 package would require PBMs to provide employers and other health plan sponsor fiduciaries with detailed prescription drug benefits tracking reports, to help the fiduciaries make sure the plan participants are getting a good deal.
The other PBM provision would require PBMs to pass all rebates and other discounts they negotiate on to the plan fiduciaries.
Entities involved in providing prescription benefits — “covered service providers” — would have to let the plan fiduciaries audit them.
Part of the rebate pass-through section would extend an existing definition of covered service provider now included in the Employee Retirement Income Security Act.
The ERISA section now says fiduciaries must track individuals or entities that help with “the development or implementation of plan design.”
The provision in the spending package would require fiduciaries to track service providers that help with “plan design, insurance or insurance product selection (including vision and dental), recordkeeping, medical management, benefits administration selection (including vision and dental), stop-loss insurance, pharmacy benefit management services, wellness design and management services, transparency tools, group purchasing organization agreements and services, participation in and services from preferred vendor panels, disease management, compliance services, employee assistance programs, or third-party administration services, or consulting services related to any such services,” according to the bill text.
The PBM provisions do not appear to classify PBMs as fiduciaries or require them to use specific types of compensation arrangements.
The spending package does not appear to include any provisions related to private-sector retirement benefits, health savings accounts, efforts to create a new framework for individual coverage health reimbursement arrangements or efforts to extend the temporary, high level of Affordable Care Act individual health insurance premium subsidies that was in effect in 2025.
The package does provide $42.1 million in funding for enforcement of the No Surprises Act provisions that seek to protect insured patients who use out-of-network emergency care or who encounter out-of-network providers at in-network hospitals from being billed for out-of-network care.
The Consolidated Appropriations Act, 2026 package: Some appropriations bills are called “omnibus bills.”
CAA 2026 is being described as an appropriations “minibus.”
The main purpose of the package is to provide the funding needed to keep many parts of the federal government operating normally after Jan. 30.
The 954-page bill includes thousands of funding provisions.
Most of the $1.2 trillion in funding provided would pay for the U.S. Department of Defense, public health programs, medical research, financial aid programs for college students and other programs with no direct connection to private-sector employer-sponsored health benefits.
Roughly $3.7 billion would go to Centers for Medicare and Medicaid Services offices that oversee many different public and private health programs, including HealthCare.gov and other Affordable Care Act ACA rules and programs.
About $191 million would go to the Employee Benefits Security Administration, the U.S. Labor Department division that sets and administers federal health benefits regulations.
The PBM provisions in the minibus package are included in a section for provisions that could lower drug costs.
The third provision in the drug cost section would require the U.S. Department of Health and Human Services to give manufacturers that are trying to get approvals for new generic drugs more information they can use to get the generics approved for sale.
The Fitzpatrick bill: The PBM provisions in the minibus package appear to be based on the PBM oversight and rebate pass-through provisions in the Bipartisan Health Insurance Affordability Act bill, a bipartisan health bill package that Rep. Brian Fitzpatrick, R-N.Y., introduced in December.
The Fitzpatrick package has 13 Republican cosponsors and nine Democratic cosponsors.
The process: At press time, the House Rules Committee was meeting to prepare the package for action on the House floor.
House Rules members were considering at least 79 proposed amendments to the package.
If the package passes on the House floor, it must then get through the Senate to reach the desk of President Donald Trump. If the president vetoes it, then Congress must overturn the veto, come up with another appropriations bill or watch much of the federal government shut down until an appropriations bill is signed into law, or policymakers come up with an alternative strategy.
Some Democrats have objected to the lack of ACA premium subsidy provisions and provisions in the package that would fund federal immigration enforcement programs.