California’s PBM Law May Become the Blueprint for Employer Oversight

Employers are about to get more visibility and control over how pharmacy benefits are managed. The new California PBM law, Senate Bill 41, requires full rebate pass-through, prohibits spread pricing and imposes fiduciary duties for pharmacy benefit managers.

Although SB 41 applies to PBMs operating in California, national vendors that serve California clients are likely to align their rebate, pricing and reporting processes across all markets to simplify compliance. For HR, the result is more transparency in drug costs and a greater need to confirm that savings on paper show up at the pharmacy counter for employees. 

Why PBM Transparency Is Gaining Ground

Pharmacy benefit oversight is gaining momentum, and the California PBM law is accelerating that change even for employers outside the state. National vendors rarely operate by state, so the steps they take to comply with SB 41 in California are likely to shape contracts, pricing models, and reporting in other markets as well.

HR and finance leaders in self-insured plans can expect more detailed rebate and fee disclosures, including line-item PBM invoices that show how dollars move from manufacturer to pharmacy. That level of detail creates leverage but also pressure to act on what the numbers reveal.

For example, if employers see that savings aren’t being passed through and ignore the issue, it can raise questions about their oversight — even though SB 41 directs fiduciary obligations primarily at PBMs.

In practical terms, HR teams across the U.S. may need to review PBM relationships with the same rigor they apply to retirement and health plan oversight, using the California PBM law as an early signal of what is coming next.

What California PBM Law Reveals About the National Landscape

California’s requirements provide the clearest preview of what broader PBM reform may look like as other states and federal agencies consider similar measures.

The new legislation pulls back the curtain on how pharmacy benefit dollars move and who controls them. It introduces changes that directly affect how employers and HR teams manage vendor relationships and renewal terms. Specifically, the law:

• Bans spread pricing, stopping PBMs from charging plans more than they reimburse pharmacies so employer costs reflect actual transactions
• Requires 100% of manufacturer rebates to pass through to the plan, giving employers proof of how savings are used
• Mandates quarterly financial reports showing rebate and pricing data that employers can use to compare vendor performance
• Establishes a fiduciary duty requiring PBMs to act in the client’s best interest and disclose conflicts of interest, and
• Enforces penalties of $1,000 to $7,500 per violation, with authority given to the state attorney general.

Most provisions apply to contracts issued or renewed after Jan. 1, 2026, putting pressure on employers to confirm compliance before the next benefits cycle.

How HR Teams Should Expect Vendor Relationships to Shift

PBM oversight is shifting to a more data‑driven model. Reports that once came in short summaries will now include detailed quarterly files that break out rebates, pricing and other plan fees. HR and finance leaders will need to interpret that data and ensure vendors are meeting fiduciary and disclosure requirements. 

Contracts will likely expand to include language confirming rebate passthrough and fiduciary duty. HR teams should anticipate heavier oversight work, such as reconciling data, verifying compliance and documenting their review process for audits.

These updates may also reshape employee communication materials if copay formulas or prescription networks change, especially when cost-share tiers are adjusted during open enrollment.

The shift is as cultural as it is procedural. HR’s role now includes financial oversight of pharmacy spending to ensure that the savings reach employees. 

What to Do Now Ahead of Pharmacy Benefit Renewals

Renewal planning for 2026 will happen under a new set of pharmacy benefit rules, and HR teams that prepare now will have an easier time adapting when the California PBM law takes effect. 

“Probably the best step HR and benefits executives can take to prepare for potential new PBM transparency rules is to work with a pharmacy care partner that is already ahead of the curve on PBM reform requirements,” said Danny Sanchez, CEO of EmpiRx Health. 

Many employers are beginning to review PBM relationships as national vendors assess how to align pricing and reporting across their client base. Key priorities include:

• Requesting sample reporting templates that show how quarterly rebate and pricing data will be shared
• Reviewing current PBM contracts and identifying where rebate passthrough, fiduciary and disclosure language may need updates
• Coordinating with brokers, consultants and finance leaders to evaluate how the end of spread pricing could shift administrative fees or total plan costs
• Updating communication materials for open enrollment if copay structures, pharmacy networks or formulary designs change, and
• Establishing a consistent PBM oversight process to verify reports, track rebates and document compliance.

Taking these steps now will make renewals smoother in 2026 and help employers stay ahead as other states and federal agencies move toward similar transparency rules inspired by the California PBM law.

What’s Next in PBM Oversight and Employer Risk

The new California PBM law is part of a national push to make pharmacy benefit management more transparent. More than 30 states already require some form of rebate or pricing disclosure. Federal agencies, including the FTC and HHS, are investigating PBM practices, signaling that stricter rules are likely ahead. What sets this law apart is how it ties fiduciary duty directly to transparency, creating a framework that other states are expected to follow.

“I would recommend engaging with a PBM partner that prioritizes improving patient health outcomes and reducing drug spending and overall costs by actively managing pharmacy benefits, not just rubber-stamping claims to inflate rebates, like the traditional PBMs,” Sanchez said.

He added that transparency rules are only the first step in the PBM reform journey and that employers should demand PBM partners put plan sponsors’ interests and patients’ clinical needs ahead of profit-driven decisions.

Employers are facing a new baseline for how pharmacy benefits are managed and measured. 

PBM accountability is now an expectation, not just a best practice. The next phase will likely include stricter state disclosure rules, new federal reporting requirements, and greater scrutiny of how employers enforce oversight. HR and finance teams that track these developments early will have stronger leverage in renewal negotiations and greater protection as transparency requirements expand.