The smaller pharmacy benefit managers (PBMs) that have long advocated for more transparent business practices secured a major win earlier this year. A new set of PBM regulations and reporting requirements were included in the Consolidated Appropriations Act of 2026 (CAA 2026), marking a shift in oversight for the industry. The trade group representing these PBMs has since changed its name from Transparency-Rx to Transparency Rising. The change reflects both the group’s annual meeting title and a broader effort to attract non-PBM companies interested in the sector’s evolving setting.
Expanding Membership, Shifting Focus
Joe Shields, CEO of Transparency Rising, explained the name change in an interview with Managed Healthcare Executive. The group’s annual meeting, now called Transparency Rising, influenced the decision. Shields also noted that the market’s complexity is drawing new members, including companies that do not traditionally identify as PBMs. “Our membership is beginning to reflect that,” he said. “We’re drawing in affiliate types of companies that aren’t technically defined as PBMs.”
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The CAA 2026 reforms require PBMs to pass through rebates and disclose information on spread pricing, acquisition costs, and rebates at least twice a year. The law also includes enforcement provisions, such as fines of $10,000 per day for failing to disclose required information and $100,000 per item for knowingly providing false data. Meanwhile, the Department of Labor has proposed overlapping regulations, which are expected to align with CAA 2026 rules in their final form.
Partnerships and Industry Trends
Transparency Rising’s website lists 11 “anchor partners” and seven “impact partners,” including companies like Kroger, Medone, and Nomi Health. The group’s May meeting in New Orleans drew about 250 attendees, signaling growing interest in its mission. However, the PBM industry remains dominated by the “big 3” — CVS Caremark, Express Scripts, and Optum Rx. Some industry observers suggest that recent regulations, along with FTC settlements, may reduce the gap between smaller PBMs and these giants as the big 3 comply with new laws.
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Shields dismissed this notion. He argued that the big 3’s business models are fundamentally different and that many new rules do not apply to them in significant ways. “There will continue to be contrasts and conflicts,” he said. “Some companies still derive revenue from spread pricing, while others do not.” This divergence highlights ongoing tensions within the industry as regulations reshape traditional practices.
The shift in the PBM sector is not just about compliance. It reflects a broader push for transparency and accountability that could influence how pharmaceutical benefits are managed in the future. As smaller PBMs gain traction, their ability to adapt to new rules may determine their role in an increasingly regulated market. Whether these changes will disrupt the dominance of the big 3 or simply refine their operations remains to be seen. The industry’s next steps will likely depend on how effectively all players handle the evolving legal and operational setting.
