Request for Information: Pharmacy Benefit Manager Compensation and Data Collection

Optum Rx (a subsidiary of UnitedHealth Group) supports the CMS Request for Information regarding PBM provisions in the Consolidated Appropriations Act of 2026. They argue that CMS should adhere strictly to statutory boundaries, preserve market-based competition, and ensure that new regulations are operationally feasible and harmonized with existing Medicare frameworks to avoid unintended cost increases.

Transparency Rising, representing companies in the pharmacy benefit management and prescription drug supply chain, submitted comments supporting a transparent and competitively neutral regulatory framework for Part D drug compensation. They provide technical input on definitions for PBMs, affiliates, and "bona fide service fees," while advocating for disclosure-based transparency and the use of existing industry data formats to reduce reporting burdens.

The PBM Accountability Project, representing a coalition of organizations, supports the proposed PBM reform and requests specific, broad language to define PBMs and their affiliates. They urge CMS to mandate comprehensive reporting of all compensation and intra-entity transfers to ensure transparency and prevent PBMs from exploiting loopholes.

The Alliance of Community Health Plans (ACHP) supports CMS's efforts to implement PBM reforms that increase transparency and tie PBM compensation to bona fide services rather than drug prices. They advocate for clear definitions of PBMs and affiliates to ensure that nonprofit, provider-aligned health plans are not inadvertently regulated as third-party PBMs.

Cencora, Inc. argues that pharmaceutical distributors, provider GPOs, and relabelers should not be classified as PBMs or "affiliates" under Section 6224 of the CAA. They contend that these entities perform distinct functions from PBMs and lack the necessary data to comply with the proposed reporting requirements.

CVS Health supports the Request for Information but urges CMS to adhere strictly to the statutory language of the CAA 2026 to avoid overbroad interpretations of PBM compensation and "affiliate" definitions. They advocate for clear, workable definitions of "bona fide service fees" and "fair market value," and request that CMS avoid imposing additional data reporting requirements beyond those already mandated by statute.

The Cigna Group supports the agency's efforts to implement the Consolidated Appropriations Act of 2026 but urges CMS to adhere strictly to the statutory language. They advocate for a principles-based, flexible regulatory approach that avoids prescriptive requirements, preserves market competition, and protects existing pharmacy reimbursement standards.

HealthHIV supports the effort to reform Pharmacy Benefit Manager (PBM) compensation in Medicare Part D but urges CMS to ensure that reforms do not simply shift costs to patients or other parts of the system. They advocate for rigorous oversight of "fair market value" fees, the establishment of firm guardrails on incentive payments, and the collection of data on patient-facing measures like medication access and out-of-pocket costs.

The National Association of Specialty Pharmacy (NASP) supports the implementation of Section 6224 but urges CMS to establish a clear, accreditation-based definition of "specialty pharmacy" and an ownership-based definition of "affiliate." They argue that CMS must ensure rules do not unfairly impact independent pharmacies and should require PBMs to disclose all pharmacy price concessions at the point of sale rather than through post-adjudication fees.

The American Pharmacists Association (APhA) supports the RFI's goal of regulating PBM compensation and data collection. They urge CMS to use a broad definition of PBMs and "affiliates," strictly define "bona fide service fees" to exclude those tied to drug prices or volume, and ensure reporting requirements are comprehensive and harmonized with other federal rules.