Q&A: FTC Settlements, PBM Reform Are Reshaping Transparency Standards

The FTC's back-to-back settlements with Express Scripts and Caremark are being felt across the pharmacy industry. For pharmacists and pharmacy professionals trying to make sense of what these agreements actually mean, experts have been vocal about the significant shift toward transparency the industry is making, among many other transformations.

“I think the bigger story around this is: Everybody needs to be transparent now,” Rae McMahan, senior vice president of payor solutions at Prescryptive Health, told Drug Topics. “Let’s move away from transparency [and] now get down to the basics and look at the prices and make sure that we have appropriate access for the members to get their medication.”

In part 2 of our interview series with McMahan, she breaks down how these landmark settlements, combined with the Consolidated Appropriations Act of 2026, are doing something the industry has talked about for years but rarely achieved: forcing real, structural transparency into PBM operations and drug pricing flows from manufacturer to patient.

McMahan goes beyond the buzzwords to examine what comes after transparency. She specifically explores how the industry can now use this regulatory momentum to redesign patient access, empower consumers with better financial decision-making tools, and ensure that the compounding weight of legislative and regulatory action translates into meaningful change at the pharmacy counter.

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Drug Topics: How does this settlement, alongside the previous Express Scripts agreement, establish a new, industry-wide compliance framework for PBM transparency?

Rae McMahan: We’ve been there, I would say, over the past few years. Transparency is the new buzzword. I think we would say transparency is ‘How opaque is it?’ What level of transparency are we talking about here? But I think the important component around the prior agreement, and then the one that we currently have, is that it’s not targeting a company, it’s targeting an industry and how it has been done before. It is pushing to the forefront where people need to understand the economics and how much money is being gained by a company. [It’s] also [understanding] how much money they’re going to pay for a medication that they need.

I think the bigger story around this is: Everybody needs to be transparent now. Let’s move away from transparency [and] now get down to the basics and look at the prices and make sure that we have appropriate access for the members to get their medication. I will read and see some of the Drug Topics articles and others where people will say, “We’ve been talking about transparency for 5 years,” or 10 years or whatever it is. “We’ve been transparent the whole entire time,” but what level is it?

I think the important thing is how do we take a step from here? If price is going to be somewhat now even, how do we allow access to come through, choices to come through for the consumer, and understand where the money flow is going and what’s happening?

Drug Topics: To what degree do these structural remedies align with legislative mandates like the 2026 Consolidated Appropriations Act to reform PBM compensation?

Rae McMahan: Overall, from a personal perspective, I was not sure honestly that this was going to go anywhere at all because of a number of different things. I think that the value of this, around the Appropriations Act in addition to the FTC findings and some of the mandates happening, is that the issue wasn’t one-sided; it wasn’t one specific finding. We’ve also taken measures around how do we make sure that we fix the problem? How do we make sure that we now have acts, if you will, to prevent this from happening again?

All of these bits of information and intent to do good for the member, I’m glad that we’re here. I think that the compounding nature of this and what this will do to the industry in helping people get their medication, we have this in so many other industries. I believe this is a great add-on, if you will. It’s a pile-on in a good way. I think what we now take from this is the opportunity to [figure out] how do we redesign how patients access the system. They didn’t have a lot of information, and the PBM was doing that or their employer was doing that without knowledge. But now, because we have these background mandates to follow, appropriate mandates to follow, how do we then transform that so that the patient has accurate decision-making when they need to make a financial and a pharmacy decision?

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