Some of those who are recovering from torn tendons, strained muscles and orthopedic surgery are increasingly turning to injectable compounds called peptides that promise faster healing, and a new federal policy is about to make them easier to get. On October 30, 2026, the U.S. Department of Health and Human Services published a Federal Register notice announcing that it will not take enforcement action against licensed pharmacies and physicians that compound six unapproved peptides, provided they meet ten conditions. The most popular of the six, BPC-157, has never been approved by the FDA for any use and has almost no human research behind it.

Peptides are short chains of amino acids, the building blocks of proteins. Some are well established medicines; insulin and the GLP-1 weight-loss drugs are peptides. The compounds covered by the new policy are different. They have been sold for years online as “research chemicals not for human use,” and they have built a following among athletes, fitness enthusiasts and wellness clinics on the strength of animal studies and social media testimonials. BPC-157 is promoted as the “Wolverine peptide” for tendon, ligament and muscle repair. TB-500 (spoken “T-B five hundred”), a fragment related to a natural protein called thymosin beta-4 (THY-moh-sin BAY-tuh four), is marketed for wound and tissue healing.

The HHS policy, signed by Secretary Robert F. Kennedy Jr., covers BPC-157, TB-500, epitalon, KPV, MOTS-c and semax. It applies to compounding under Section 503A of the federal drug law, the provision that lets state-licensed pharmacies and physicians prepare customized medications for individual patients with a prescription. According to The American Journal of Managed Care, the conditions require that the raw ingredient come from an FDA-registered manufacturer with a certificate of analysis showing identity, purity and potency, that each product contain only one active ingredient, that it be labeled as a compounded drug, and that serious adverse events be reported to the FDA. Each peptide is limited to particular routes; BPC-157, for example, may be compounded for injection under the skin or into muscle, by mouth or for topical use.

It is important to be precise about what the policy does. It is not FDA approval, and it does not add the peptides to the official list of ingredients that pharmacies may lawfully use in compounding. It is a statement that HHS does not intend to enforce the law against compounders who follow its conditions while the FDA decides, through rulemaking whether each substance belongs on that list. HHS says the goal is to steer users away from gray-market products made overseas toward a more controlled source. The policy is labeled a draft, HHS may revisit it if safety or quality problems emerge, and comments were due two weeks after publication.

The decision overrode the agency’s own scientists. In July, the FDA’s Pharmacy Compounding Advisory Committee voted 8 to 6, with one abstention, to recommend BPC-157, KPV and TB-500 for the compounding list, and ultimately recommended six of the seven peptides it reviewed, after career FDA reviewers had recommended against all seven. CNN reported that FDA officials warned their scientific staff would not support a regulation deeming the peptides safe, and that Kennedy has called himself a fan of peptides and has described using BPC-157 for a muscle injury.

The clinical evidence is thin. FDA briefing materials found the available studies, including five on BPC-157, too short and small to establish safety or effectiveness. In a November 5 commentary in Healio’s Orthopedics Today, the authors noted that most BPC-157 animal research comes from a single laboratory, none of it has examined healing after surgical repair, and the human evidence consists of a single case series. The first randomized, placebo-controlled pilot study, in patients after rotator cuff repair, is not scheduled to begin until January 2027. In a separate Healio feature, sports medicine surgeon Jason Dragoo said there is really no human clinical data showing BPC-157 improves healing or performance. Researchers have also debated whether the peptide’s tendency to stimulate new blood vessel growth, called angiogenesis could carry long-term risks.

Use is climbing regardless. A preprint analysis of clinical notes found newly confirmed BPC-157 users rose about 33-fold between early 2020 and early 2026, and about a third of those who documented a source obtained it from gray-market vendors. Product quality is a real concern: an obesity medicine specialist told AJMC that gray-market peptides often contain 5 to 75 percent of the labeled amount, and some carry contaminants. The FDA’s adverse event database has logged 10 serious reports tied to BPC-157 since 2021, eight of them in 2026, though such reports do not prove the drug caused the problem. BPC-157 and TB-500 are also on the World Anti-Doping Agency’s prohibited list.

The workers’ compensation implications start with treatment requests. Some treating physicians, particularly in sports medicine and wellness-oriented practices, may now request authorization for compounded BPC-157 or TB-500 after tendon and soft-tissue injuries. Utilization reviewers will be weighing products that are not FDA approved for any indication and lack published human trials in musculoskeletal healing, against evidence-based treatment standards such as California’s Medical Treatment Utilization Schedule. The workers’ compensation system has a long history of disputes over compounded medications, and payers will want to know the dispensing pharmacy, the source of the raw ingredient and whether the product meets the policy’s conditions. The federal policy does not require any payer to cover these drugs, and AJMC notes that compounded drugs generally fall outside standard pharmacy benefits.

The second issue is undisclosed self-treatment. Because BPC-157 has no national drug code, it never appears on a structured medication list or a pharmacy claim. Many injured users are buying peptides on their own. and may not mention them to a surgeon or a claims examiner. Surgeons are now being urged to ask about peptide use before operating, and claims professionals reviewing pre-operative records may want to see whether that question was asked.

The policy remains in effect until the FDA finishes rulemaking on each peptide, a process AJMC says can take 12 to 24 months, and it could be revised sooner if safety signals emerge. The rotator cuff pilot trial in 2027 may offer the first controlled human data relevant to work injuries. Until then, claims professionals should treat peptides as an unproven, self-directed treatment that is becoming easier to obtain, and ask about it early when soft-tissue injuries and orthopedic surgery are involved.

California’s Contractors State License Board (CSLB) has taken 73 enforcement actions against suspected unlicensed and noncompliant contractors after a series of 39 undercover stings and job-site sweeps across the state. The operations were part of a 15-state crackdown coordinated by the National Association of State Contractors Licensing Agencies (NASCLA), and the board announced the results on November 2, 2026, according to a republication of the release by the California Statewide Law Enforcement Association. The CSLB’s home page also lists the announcement.

In the sting operations, which CSLB ran with local law enforcement in three counties it did not name, investigators answered advertisements placed by suspected unlicensed operators and arranged for them to come to designated locations to bid on projects. Those jobs ranged in value from $1,100 to $35,000. The stings produced 25 misdemeanor Notices to Appear for unlicensed contracting and illegal advertising, 10 administrative citations, and six referrals to district attorneys for possible prosecution.

The sweeps covered 18 counties, where CSLB investigators made 182 visits to active job sites. Those checks led to 11 cases referred to local district attorneys, 13 citations against licensed contractors, six citations against unlicensed individuals, and two Letters of Admonishment. Investigators also issued 11 stop work orders and 20 advisory notices, which the board reported separately from the 73-action total. The release did not break down how the 39 operations were divided between stings and sweeps, and it did not say how many of the violations involved missing workers’ compensation coverage.

CSLB Registrar David Fogt said in the release that unlicensed activity “often crosses state lines,” and he credited the multistate effort with sending a unified message. The board said individuals who were cited also received information to encourage them to become licensed and comply with the law.

The board reminded the public that California law bars unlicensed contractors from bidding on or contracting for any project that requires a building permit, uses employee labor, or is valued at $1,000 or more in combined labor and materials. Unlicensed contracting is a misdemeanor under Business and Professions Code § 7028. The $1,000 “minor work” threshold appears in Business and Professions Code § 7048.

CSLB warned that unlicensed operators often carry neither a license nor the required workers’ compensation insurance, which can leave homeowners on the hook for accidents or damage. Every California employer must secure workers’ compensation coverage under Labor Code § 3700, and licensed contractors must keep a current certificate of coverage, or a valid exemption, on file with CSLB under Business and Professions Code § 7125.

Unlicensed operators fall outside that system entirely. When one of their workers is hurt, the cost often shifts elsewhere. Under Labor Code § 2750.5, a person performing work that requires a contractor’s license is presumed to be an employee unless he or she holds that license. That presumption can expose a hiring property owner or general contractor to claims, and their own insurers with them. Unlicensed operators also compete for work without paying premiums, undercutting legitimate contractors who bear the cost of coverage.

This year’s total is lower than the board’s results from earlier NASCLA campaigns. CSLB reported 119 legal actions from its 2025 operations and 229 in 2024, though the scope and number of operations vary from year to year, so the totals are not directly comparable. CSLB licenses about 285,000 contractors in 45 classifications. Consumers can verify a license or report suspected unlicensed activity at cslb.ca.gov or by calling 1-800-321-CSLB (2752).

In 2023, California enacted two companion climate-disclosure statutes. The Climate Corporate Data Accountability Act, known as SB 253 and codified at Health and Safety Code § 38532, applies to entities doing business in California with more than $1 billion in annual revenue. It requires them to report their greenhouse gas emissions each year under the Greenhouse Gas Protocol in three categories: Scope 1 (direct emissions from sources the company owns or controls), Scope 2 (emissions from energy the company purchases), and Scope 3 (indirect upstream and downstream emissions across the company’s value chain, from sources it does not own or control). The Climate-Related Financial Risk Act, known as SB 261 and codified at Health and Safety Code § 38533, applies to companies with more than $500 million in annual revenue doing business in California. It requires a biennial report on the company’s “climate-related financial risk” under the framework of the Task Force on Climate-related Financial Disclosures, along with the measures the company has adopted to reduce and adapt to that risk. According to the dissent, both laws carry administrative penalties and annual fees payable to the California Air Resources Board (CARB).

The U.S. Chamber of Commerce, the California Chamber of Commerce, the American Farm Bureau Federation, the Los Angeles County Business Federation, the Central Valley Business Federation, and Western Growers Association sued the CARB chair and executive officer and the California Attorney General in the Central District of California. They alleged that both statutes facially violate the First Amendment by compelling speech. Other, non-First Amendment claims were not part of this appeal.

The district court denied the business groups’ motion for a preliminary injunction. It concluded that both laws regulate commercial speech, so strict scrutiny did not apply. It reviewed SB 261 under intermediate scrutiny and SB 253 under the more deferential standard of Zauderer v. Office of Disciplinary Counsel (1985) 471 U.S. 626, and found that the plaintiffs had not shown a likelihood of success, irreparable harm, or that the equities and public interest favored them. The plaintiffs appealed under 28 U.S.C. § 1292(a)(1). On November 18, 2025, the Ninth Circuit enjoined enforcement of SB 261 pending appeal, but declined to do the same for SB 253.

In the published case of Chamber of Commerce of the United States of America v. Sanchez, No. 25-5327 (November 2026), the Ninth Circuit Court of Appeals affirmed in part, reversed in part, and remanded the district court’s order denying a preliminary injunction. The panel affirmed the denial as to SB 253’s Scope 1 and Scope 2 emissions disclosures, which may therefore proceed. It reversed the denial as to SB 253’s Scope 3 disclosure requirement and as to SB 261 in its entirety, finding both likely unconstitutional. It remanded for the district court to decide in the first instance whether the Scope 3 provision can be severed from the rest of SB 253, which contains a severability clause.

The court began with the governing framework. Content-based compelled speech is presumptively unconstitutional and draws strict scrutiny, as in X Corp. v. Bonta (9th Cir. 2024) 116 F.4th 888 and National Institute of Family & Life Advocates v. Becerra (2018) 585 U.S. 755. Commercial speech generally receives intermediate scrutiny under Central Hudson Gas & Electric Corp. v. Public Service Commission (1980) 447 U.S. 557, and purely factual, uncontroversial disclosures may receive the lighter Zauderer review. The preliminary-injunction factors came from Winter v. Natural Resources Defense Council (2008) 555 U.S. 7.

Scope 1 and Scope 2. Relying heavily on Pharmaceutical Research & Manufacturers of America v. Stolfi (9th Cir. 2025) 153 F.4th 795, the majority held that these provisions compel factual emissions information bearing on a company’s own operations and its risk profile in capital markets, and therefore regulate commercial speech. It rejected the argument that commercial speech is limited to speech proposing a transaction. The court did not decide whether Zauderer or intermediate scrutiny applied, because the provisions likely survive the tougher intermediate test. The State had substantial interests in giving investors better information and in reducing emissions, though the court found no record support for a separate anti-“greenwashing” rationale. Studies showing that mandatory Scope 1 and 2 reporting produced emissions reductions of roughly 7 to 8 percent persuaded the court that the requirements directly advance those interests and are not more extensive than necessary. The facial challenge also failed under Moody v. NetChoice, LLC (2024) 603 U.S. 707, because most covered companies are publicly traded, so any unconstitutional applications do not substantially outweigh the lawful ones. On the remaining factors, the plaintiffs showed no irreparable harm, and the equities favored the State.

Scope 3. The court reached a different result for value-chain emissions. Because Scope 3 concerns diffuse conduct by third parties rather than the company’s own operations, the panel held it is not tethered closely enough to the company’s commercial transactions to qualify as commercial speech, so strict scrutiny applies. The State could not carry that burden. Companies do not hold Scope 3 data the way they hold their own emissions data, and the record did not show their estimates would be more reliable than the State’s own. The link to investor decisions was too attenuated, and no study examined mandatory Scope 3 reporting, so the emissions-reduction evidence did not support it.

SB 261. The court held that climate-risk reports require predictive and normative judgments, under a state-prescribed framework, on a politically charged subject. That makes them noncommercial speech subject to strict scrutiny, which the majority said the State had “all but concede[d]” it could not satisfy. Even assuming compelling interests, SB 261 was not narrowly tailored, because less restrictive options existed, such as publicizing voluntary disclosures or regulating emissions directly. For both SB 261 and Scope 3, the loss of First Amendment freedoms constituted irreparable harm, and the equities and public interest favored the plaintiffs.

The partial dissent. Judge Bennett would have treated both statutes as compelling noncommercial speech and enjoined them both. In his view, commercial speech requires a close tie to a specific product or service, and firm-level emissions data informs readers about companies, not particular products. He warned that equating investors’ interest in companies with consumers’ interest in products could justify broad compelled disclosures, including ones aimed at people in employment markets, citing Valle del Sol Inc. v. Whiting (9th Cir. 2013) 709 F.3d 808.

In a same-day client alert, Foley & Lardner observed that SB 253’s Scope 1 and 2 filing deadline remains November 10, 2026, the day after the ruling, and said it expects the district court to enter a preliminary injunction against the Scope 3 and SB 261 requirements in line with the opinion. That November 10 date reflects CARB’s extension of the original August 10, 2026 first-year deadline, as described in CARB’s rulemaking materials. Further review, either by the full Ninth Circuit or the U.S. Supreme Court, remains possible.

This unpublished California Court of Appeal opinion, which under California Rules of Court, rule 8.1115 generally may not be cited or relied on by other courts or parties, is the latest chapter in a long-running dispute over payment by an employer for SCIF insurance over a single policy year. State Compensation Insurance Fund (SCIF) issued a 2005 workers’ compensation policy to ReadyLink Healthcare, Inc., a nurse staffing company, with an estimated premium of $250,000 that ReadyLink paid up front. After the policy year closed, SCIF audited ReadyLink’s payroll and other records to set the final premium retroactively, with any difference to be settled by an additional payment or a refund.

The dispute centered on per diem payments to ReadyLink’s nurses, which were generated by proprietary software and which ReadyLink did not require nurses to document. Counting those payments as compensation produced an additional premium of $555,327.53. As the Court of Appeal recounted in an earlier published opinion, the Insurance Commissioner approved SCIF’s application of the relevant regulation, and ReadyLink’s writ challenge to that decision failed. SCIF then sued for breach of contract in Riverside County Superior Court to collect the additional premium.

The trial court first granted SCIF judgment on the pleadings, but the Court of Appeal reversed in State Comp. Ins. Fund v. ReadyLink Healthcare, Inc. (2020) 50 Cal.App.5th 422. At the jury trial on remand, SCIF presented a premium collection specialist and a certified public accountant to support the $555,327.53 figure. ReadyLink did not rebut them, stipulated that the invoice arithmetic was correct, and relied on a waiver defense. The jury rejected waiver but nonetheless found that ReadyLink owed no additional premium. The trial court granted judgment notwithstanding the verdict for the full $555,327.53, and the Court of Appeal affirmed in the unpublished opinion of State Compensation Ins. Fund v. ReadyLink Healthcare (May 8, 2026, D083359).

While ReadyLink’s appeal from that judgment was pending, SCIF moved for prejudgment interest under Civil Code § 3287. SCIF asked for $907,998.38 under subdivision (a), measured from 30 days after it invoiced ReadyLink through the date of judgment. In the alternative, it proposed $912,562.71 under subdivision (a) measured from the invoice date, or $493,404.61 under subdivision (b) measured from the filing of the action. After oral argument, the Riverside County Superior Court (Judge Kira L. Klatchko) awarded the $907,998.38. ReadyLink appealed, without disputing SCIF’s math.

In the unpublished case of State Compensation Insurance Fund v. ReadyLink Healthcare, Inc., No. D086046 (November 2026), the California Court of Appeal, Fourth Appellate District, Division One, affirmed the postjudgment order awarding SCIF $907,998.38 in prejudgment interest.

The panel started with the two parts of section 3287. Subdivision (a) provides for nondiscretionary interest on liquidated damages, while subdivision (b) gives courts discretion over interest on unliquidated contract damages, as explained in Hewlett-Packard Co. v. Oracle Corp. (2021) 65 Cal.App.5th 506. Reviewing the subdivision (a) award de novo under KGM Harvesting Co. v. Fresh Network (1995) 36 Cal.App.4th 376, the court noted that the provision “requires both certainty and vesting,” quoting International Currency Technologies v. ICT, Inc. (2025) 112 Cal.App.5th 639. That test compensates plaintiffs for the lost use of their money, and it protects defendants by limiting mandatory interest to cases where the amount owed is certain, drawing on Watson Bowman Acme Corp. v. RGW Construction, Inc. (2016) 2 Cal.App.5th 279.

The court found both requirements met. The damages were certain because the amount came from ReadyLink’s own payroll records, two witnesses corroborated it without being impeached or rebutted, and ReadyLink’s counsel conceded at trial that he would not dispute the calculation. The damages vested on the day SCIF’s properly calculated invoice had remained unpaid for 30 days, so interest ran from that day and the award was mandatory.

ReadyLink argued that SCIF was not obligated to collect the premium, could have enforced its position only prospectively, and offered no evidence that it needed the money. The panel found these points indistinguishable from those it had already rejected as irrelevant to damages in its May 2026 opinion, which it could cite as law of the case under rule 8.1115(b)(1). That opinion reasoned that a promisee is injured by a breach even if it can get by without the money: “If it received less than what it bargained for, it is harmed.”

Two further arguments failed in footnotes. Having to prove the amount at trial did not make it uncertain, the court said, because damage and its amount are elements of every breach of contract action. ReadyLink also contended at oral argument that the disputed per diem inputs made the damages uncertain, but its reply brief acknowledged it never disputed that the invoice arithmetic was calculable, and the court noted an administrative law judge’s conclusion that ReadyLink did not require nurses to document per diem expenses.

Finally, ReadyLink asked the court to shorten the interest period under subdivision (b) by excluding the time before SCIF filed suit and the time its appeal of the pretrial judgment was pending. Because subdivision (b) applies only to unliquidated damages and these damages were liquidated, the trial court had no discretion to shorten the period.

For years, employers have paid pharmacy benefit managers to hold down prescription drug costs without being able to see how much those PBMs were earning along the way. A new federal rule is meant to change that. The Department of Labor’s Employee Benefits Security Administration released a final regulation on October 29, 2026, and published it in the Federal Register on November 2. It requires PBMs, along with brokers and consultants affiliated with them, to disclose in dollars the rebates, fees, markups and other compensation they collect when serving large self-insured employer health plans. Whether the rule actually lowers drug spending will depend on what employers do with that information.

Why did PBMs become a lightning rod. PBMs sit in the middle of the prescription drug supply chain. They negotiate rebates from drug manufacturers, build formularies, set up pharmacy networks and process claims for health plans. According to the Labor Department, the self-insured employer plans they serve cover about 90 million Americans. The industry is highly concentrated: CVS Caremark, Cigna’s Express Scripts and UnitedHealth’s Optum Rx handle roughly 80 percent of U.S. prescriptions. Each is also part of a company that owns insurers and pharmacies.

Critics say those arrangements produce conflicts of interest. When a PBM’s revenue rises with the size of the rebates it negotiates, it may prefer drugs with high list prices and big rebates over cheaper alternatives. “Spread pricing” lets a PBM bill a plan more for a drug than it pays the pharmacy and keep the difference. PBMs can also steer patients to pharmacies they own. A January 2025 Federal Trade Commission staff report found that pharmacies affiliated with the three largest PBMs earned more than $7.3 billion above estimated acquisition costs on specialty generic drugs from 2017 through 2022. Those drugs included medications for cancer and HIV. The PBM industry rejects these criticisms and maintains that its negotiating power lowers net drug costs for plans and patients.

What has been done so far. Reform has moved slowly. Congressional packages stalled repeatedly, including a bipartisan deal stripped from a year-end spending bill in December 2024. In the meantime, states passed their own laws, but federal courts have often blocked them. Arkansas’s first-in-the-nation ban on PBMs owning pharmacies was put on hold in Express Scripts, Inc. v. Richmond (E.D. Ark. July 28, 2025), No. 4:25-cv-00520. The district court found the law likely violates the Commerce Clause and is likely preempted by federal law governing TRICARE. Arkansas appealed, and the Eighth Circuit heard argument on September 22, 2026. A ruling is still pending. Separately, in Flowers v. Caremark PCS Health (8th Cir. June 29, 2026), No. 25-3068, the Eighth Circuit held that ERISA preempts Arkansas’s requirements for how close network pharmacies must be to patients. That decision narrows how far states can regulate PBMs that serve employer plans.

At the federal level, the pace finally picked up this year. In April 2025, President Trump signed an executive order directing the Labor Department to write PBM disclosure rules, and the department proposed them in January 2026. On February 3, 2026, Congress enacted PBM reforms in the Consolidated Appropriations Act, 2026. Beginning in 2028, the law ties PBM pay in Medicare Part D to flat service fees rather than drug prices or rebates. For employer plans, it confirms that PBMs must disclose their compensation under ERISA. It also requires PBMs to pass 100 percent of rebates and similar payments through to ERISA plans for plan years beginning on or after August 3, 2028. Meanwhile, the FTC’s 2024 lawsuit accusing the three largest PBMs of inflating insulin prices has largely ended in settlements. Express Scripts settled in February and Caremark in July, and a proposed settlement with Optum Rx is under review. All three PBMs denied the FTC’s allegations.

Much of this is still on paper. The major federal changes do not take effect until 2027 through 2029, so employers and patients have not yet felt most of the effects.

What the new rule requires.The final rule is built on ERISA section 408(b)(2). That provision lets a plan pay a service provider only if the arrangement is reasonable and the compensation is no more than reasonable. It applies to self-insured plans of employers that averaged at least 100 employees in the prior year, and to similarly sized multiemployer plans, where a PBM expects at least $1,000 in compensation. According to an analysis by Mayer Brown, fully insured plans are excluded from the detailed requirements. So are plans sponsored by drug manufacturers, wholesalers or PBMs.

Before a contract is signed or renewed, a PBM must disclose its direct fees and the manufacturer rebates it expects, broken out drug by drug and showing how much it keeps versus passes through. It must also disclose spread compensation by drug and dispensing channel, money clawed back from pharmacies, formulary incentives, payments due on termination and the net price per fill. After that, it must report what it actually received every six months, or quarterly if the plan asks, within 30 days after each period ends. Any category that exceeds the estimate by 5 percent or more must be explained. Plans also get an annual audit right using an auditor of their choosing. The PBM must produce the data within 60 days, at its own expense.

The consequences fall on both sides. If a PBM fails to comply, the arrangement becomes a prohibited transaction under ERISA. The PBM faces civil penalties, and the plan’s fiduciaries are protected only if they follow the rule’s steps for requesting the missing information, reporting the failure to the Labor Department and deciding whether to keep the PBM. The rule takes effect January 4, 2027, and applies to plan years beginning on or after July 1, 2027. For calendar-year plans, that means January 1, 2028.

What difference it might make. The Labor Department estimates the rule could lower drug costs for plans and participants by as much as $22 billion over 10 years. Labor Secretary Keith Sonderling called it “a win for every American worker.” Community pharmacists, through the National Community Pharmacists Association, applauded the rule. A bipartisan group of 45 state attorneys general had backed the proposal. The industry sees it differently. The Pharmaceutical Care Management Association, which represents PBMs, argued that the rule duplicates the 2026 law and will burden smaller PBMs. PCMA President David Marin said detailed “pharmacy-by-pharmacy transparency is already law.” In its comments on the proposal, the group pointed to the Supreme Court’s 2024 decision limiting deference to agency interpretations, which suggests a court challenge is possible.

The rule’s limits are significant. It does not set drug prices, cap PBM fees or by itself require PBMs to pass savings through; that pass-through comes from the 2026 law in 2028. Small employers and fully insured plans fall outside its detailed requirements. Because the rule applies only to ERISA group health plans, it does not reach workers’ compensation pharmacy costs, which are governed by state law.

For covered employers, the rule offers leverage and creates new duties. Plan sponsors will be able to compare PBM bids on actual dollars instead of advertised rebate guarantees. They will also be expected to review the disclosures, follow up when information is missing and document their conclusions. Benefits attorneys are already advising clients to build at least 90 days into renewals to receive the initial disclosures, and to negotiate audit and termination rights now. The rule gives employers the information. Whether costs come down depends on whether they use it.