OKLAHOMA CITY (April 15, 2026) – Attorney General Gentner Drummond today led a coalition of 45 attorneys general in calling on the U.S. Department of Labor to adopt a new rule requiring pharmacy benefit managers (PBMs) to be more transparent about how they set prescription drug prices.
PBMs manage prescription drug benefits on behalf of health insurers and employer health plans. They negotiate rebates with drug manufacturers, decide which drugs are covered and determine what patients pay. Oftentimes though, the employers who hire them to manage their health plans have little visibility into how PBMs make money or why drug costs change. Approximately 136 million Americans receive health coverage through an employer.
The proposed rule would require PBMs to disclose twice a year how they generate revenue and give employers the right to audit them.
“When Oklahomans and their employers are paying more for prescription drugs, they deserve to understand why,” said Drummond. “This rule would bring much-needed clarity to a complex system and give employers the tools to make better decisions for the people they cover. I’m proud to lead this effort alongside attorneys general from across the country.”
In a letter to the Department of Labor, the coalition urges the adoption of two additional protections. First, they ask the Department to clarify that the rule does not override existing state PBM transparency laws. This is an important safeguard since PBMs have historically argued that federal law preempts state oversight. Second, they ask the Department to commit to coordinating enforcement with state attorneys general, including by referring potential violations of state law to their offices.
The Attorney General’s PBM Compliance and Enforcement Unit has taken its own steps to hold PBMs accountable, conducting ongoing investigations and negotiations with PBMs to resolve violations. It has also secured a $32 million settlement to recover funds for the state employee health plan and reached an agreement returning improperly recouped audit payments to Oklahoma pharmacies.
Those efforts reflect a nationwide trend. All 50 states, the District of Columbia, and Puerto Rico have enacted PBM regulations, including limits on out-of-pocket costs, bans on "gag clauses" that prevent pharmacists from telling patients when paying out of pocket is cheaper than using insurance, and protections for independent pharmacies. Today, the top three PBMs control roughly 80% of prescription drug claims nationwide.
