The U.S. healthcare industry is entering a pivotal moment in its debate over pharmacy benefit transparency, and HR executives—especially those overseeing self-insured health plans—are increasingly at the center of it.
In Congress, lawmakers have introduced legislation aimed at improving visibility into how pharmacy benefit managers (PBMs) operate and how prescription drug prices are set, while a growing number of lawsuits challenge opaque pricing practices, rebate arrangements and whether plan sponsors exercised appropriate oversight. Public scrutiny is rising as well, with high-profile business figures like Mark Cuban using conference stages, media interviews and social channels to urge employers to demand greater transparency (an argument that aligns with his business interest in reshaping how prescription drugs are priced and purchased). And that pressure has reached PBMs themselves: As of 2025, the CEOs of the three largest PBMs have all publicly stated that rebates would be returned to customers.
Against this backdrop, HR leaders need a clearer understanding of how pharmacy benefits actually work and what increasing calls for transparency could mean for their responsibilities going forward.