FTC warns PBM practices are driving higher drug costs and employers start to push back

TAMARAC, Fla. – US-Rx Care, the nation's first fiduciary pharmacy risk manager and an industry leader since 2007, is issuing an urgent strategic call-out to employers: the Pharmacy Benefit Manager (PBM) industry has reached a point of no return. After years of hidden incentives, conflicts of interest, and complex revenue models, mounting federal audits, fiduciary litigation, and expanding state regulations are dismantling the industry's long-standing "opacity premium."

These forces make 2026 more than just another year of policy debate. They mark a structural shift where employer governance and market pressure converge to force reform. US-Rx Care advises plan sponsors that they can no longer rely on traditional PBM contracting models and must proactively move to fiduciary standards to stabilize financial and regulatory risk.

"Employers should be asking: Why are we seeing an uptick in government involvement at the federal and state level?" said Renzo Luzzatti, co-founder and CEO of US-Rx Care. "The answer is that this is a broken system. The PBM industry has operated for too long with hidden incentives and too little accountability. It has become deeply problematic. That is why regulators are stepping in and why employers are demanding real change."

The "Opacity Premium" Collapses as Employers Become Investigators

For decades, employer-sponsored plans quietly financed the U.S. prescription drug system. That purchasing behavior is now changing. Plan sponsors are shifting from passive acceptance of PBM terms to active verification and accountability.

As federal regulators demand greater disclosure of drug-level economics, formulary decisions, and conflicts of interest, employers must recognize their own ERISA-defined fiduciary obligations. The Federal Trade Commission has documented how major PBMs extract value through pricing and steering dynamics that prioritize profit over affordability for plans and patients.

As these legacy revenue models face regulatory and legal pressure, the traditional PBM sector will likely enter a period of contract renegotiation and structural adjustment. That transition creates volatility for employers locked into opaque contracts.

"What's happening now will force major changes to the traditional PBM revenue model," Luzzatti stated. "They will likely have to re-contract everything. The real question is: where will hidden margins be captured going forward, and what will the impact be on plan management and patients?"

Litigation and Regulation Force a Fiduciary Power Shift

This structural shift is accelerated by external pressures that are turning pharmacy benefits from an administrative function into a board-level fiduciary responsibility. The discussion has moved beyond price negotiation to duty of care, disclosure, and enforceable accountability.

• Fiduciary Pressure Changes the Dynamic. Employers are increasingly being held accountable for the performance of their health plans. The Consolidated Appropriations Act and expanding ERISA enforcement make clear that generalized assurances of "lowest net cost" are insufficient. Plan sponsors must demand contractual commitments and measurable proof that their PBM acts in the best interest of the plan and its members.
• Litigation Is Accelerating Reform. High-profile lawsuits against major corporations for breaches of fiduciary duty in health benefit oversight have become a wake-up call. These cases highlight the risks of relying on conflicted advisors and opaque pricing structures. Litigation is removing the plausible deniability that allowed the flawed system to persist.
• States Are a Laboratory for Reform: While federal debate continues, states including Arkansas, Florida, and California are taking direct action. Aggressive regulatory measures are challenging PBM practices and eliminating traditional revenue strategies. This momentum signals a more restrictive environment ahead for legacy PBMs.

Together, these developments move PBM reform from policy discussion to fiduciary reality. Employers must align accordingly in 2026 and beyond.

Luzzatti cautions against waiting for government action to fix it all. "Will the government eliminate all conflicts of interest from the PBM industry? Can oversight alone fix a broken system and force true fiduciary alignment?" He said. "While there is a lot in the news about PBM reform, employers do not need to wait for regulators to solve a decades-old problem. They can act now."

The Inevitability of the Fiduciary Model

As the market confronts this structural reset, US-Rx Care's fiduciary PBM model is no longer a niche alternative. It is becoming the baseline standard for financial and compliance risk management. The narrative is shifting from optional transparency to fiduciary accountability, a higher and legally enforceable standard. The solution to the PBM crisis is not legislative. It is contractual.

US-Rx Care provides employers with a conflict-free model that eliminates pharmacy ownership, operates on a 100 percent pass-through basis for discounts and rebates, and charges a transparent administrative fee. This structure offers operational clarity and fiscal alignment at a time of industry disruption.

"The solution is already available," Luzzatti concluded. "It starts with changing how you purchase pharmacy benefit services and demanding fiduciary accountability. Employers can take control today by moving to a fiduciary PBM model that eliminates conflicts of interest and aligns plan management with the best interests of plan and members. While regulatory wheels turn at the federal and state level, plan sponsors do not have to wait."