This year, a combination of rising pharmacy costs and increased regulatory risk has led to a tipping point for the PBM industry. In the face of regulatory scrutiny and litigation, US-Rx Care CEO Renzo Luzzatti believes that employers cannot wait for government intervention to change in the industry.
TAMARAC, Fla., March 2, 2026 /PRNewswire/ — 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.”
About US-Rx Care
US-Rx Care is revolutionizing America’s pharmacy benefits system by replacing opaque, profit-driven PBMs with a fiduciary model that puts employers and members first. Founded in 2007, the company combines clinical rigor, ethical contracting, and data-driven oversight to cut drug costs by up to 50% or more while also improving health outcomes. Operating under a legally binding ERISA fiduciary standard, US-Rx Care eliminates conflicts of interest, passes through 100% of manufacturer rebates and pharmacy discounts, and delivers measurable savings without compromising care. Privately owned and free from outside financial influence, US-Rx Care is setting the new standard for pharmacy benefit management—restoring trust, accountability, and real control for employers, benefits consultants, and health plans nationwide. To learn more, visit www.us-rxcare.com.
References:
Benefits Law Advisor (Jan. 15, 2026): Proposed Legislation to Make PBMs ERISA Fiduciaries and Disclose Compensation benefitslawadvisor.com/2026/01/articles/pbm/proposed-legislation-to-make-pbms-erisa-fiduciaries-and-disclose-compensation/
Federal Trade Commission (Jan. 14, 2025): FTC Releases Second Interim Staff Report on Prescription Drug Middlemen (PBMs). ftc.gov/news-events/news/press-releases/2025/01/ftc-releases-second-interim-staff-report-prescription-drug-middlemen
FTC Report (Jan. 2025): Specialty Generic Drugs: A Growing Profit Center for Vertically Integrated PBMs. ftc.gov/reports/specialty-generic-drugs-growing-profit-center-vertically-integrated-pharmacy-benefit-managers
AP News (Apr. 2025): Arkansas bans pharmacy benefit managers from owning pharmacies in state. apnews.com/article/9e2449a2ac7f7aa206cd49f9211447b3
Axios (Jun. 9, 2025): PBM trade group sues Arkansas over pharmacy law. axios.com/2025/06/09/arkansas-pharmacy-law-pbm
PharmaVoice (Jun. 16, 2025): Locked in a federal stalemate, states take PBM reform into their own hands. pharmavoice.com/news/federal-drug-pricing-state-pbm-reform-arkansas-ban/750726/
National Law Review / Mintz (May 6, 2025): Arkansas Law Takes Unprecedented Step to Prohibit PBM Ownership of Pharmacies. natlawreview.com/article/arkansas-law-takes-unprecedented-step-prohibit-pbm-ownership-pharmacies
Congress.gov: PBM Reform Act of 2025 (bill text). congress.gov/bill/119th-congress/house-bill/4317/text/ih
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SOURCE US-Rx
