Several major healthcare insurers, notably UnitedHealth Group Inc., CVS Health Corp., and Humana Inc., have recently experienced declines in their stock values amid regulatory shifts that potentially curb their profitability on multiple fronts. While initial investor focus was on a newly proposed near-zero increase in Medicare Advantage payments by the federal government, a subsequent regulatory development has cast a spotlight on the business practices of Pharmacy Benefit Managers (PBMs), threatening profit margins in a different yet significant segment of their operations.
On January 29, the U.S. Department of Labor (DOL) unveiled a proposed regulation aimed at enhancing transparency within PBM transactions. PBMs, the intermediaries managed by companies such as CVS (through Caremark), UnitedHealth (via OptumRx), and Cigna (operating Express Scripts), handle drug benefit programs for approximately 90 million Americans enrolled in self-insured group health plans.
This regulatory initiative demands comprehensive disclosure of compensation received by PBMs from these health plans. Central focus areas of the rule include practices called "spread pricing," wherein the PBM charges the health plan more for a medication than the amount reimbursed to the pharmacy; rebates obtained from drug manufacturers—which critics argue are often retained by PBMs without being passed on to employers or patients; and clawbacks, payments that PBMs recover from pharmacies.
DOL Secretary Lori Chavez-DeRemer emphasized that eliminating opaque fees and incentives will ultimately benefit American workers and their families, stating that there is no place for hidden fees within the healthcare system. The proposal seeks to shed light on elements previously concealed within complex PBM arrangements.
The timing of this rule coincides with increased scrutiny on rebate handling by PBMs. A report published earlier in January alleged that some large insurers deploy "shell companies" or Group Purchasing Organizations (GPOs) as mechanisms to obscure billions of dollars in fees. These entities are said to channel payments through subsidiaries located in offshore locations, including Ireland and Switzerland, which collect substantial fees from drug manufacturers.
The DOL’s regulation is explicitly designed to close such loopholes by requiring that compensation conveyed through affiliates and agents—including GPOs and rebate aggregators—be transparently disclosed to plan fiduciaries overseeing healthcare plans.
Prior to the DOL’s announcement, healthcare insurers were already contending with adjustments on the Medicare Advantage front. The Centers for Medicare and Medicaid Services (CMS) proposed an average payment increase of only 0.09% for 2027, a figure far below the anticipated 4% to 6% range that analysts had forecast. This unexpected flattening of Medicare Advantage payments resulted in a swift market reaction wiping out roughly $90 billion in sector value—with Humana’s stock descending over 13%, and UnitedHealth’s falling nearly 9%, immediate after the news.
Meanwhile, the new DOL proposal edges toward curtailing the profitability of PBM operations by tackling opaque fee structures and practices which have been significant revenue contributors for these firms.
The combined effect of a capped Medicare Advantage rate and mandated transparency in PBM fee arrangements raise concerns about sustained earnings pressures for major healthcare organizations. Companies like CVS, UnitedHealth, and Cigna, which count PBM services as substantial revenue streams, may need to navigate a future of constrained top-line growth and narrower margins.
Deputy Secretary Keith Sonderling highlighted that the DOL’s measure fulfills a pledge to reform a fractured healthcare marketplace by introducing radical transparency enabling employers to gain visibility into all fees charged, thus facilitating more informed negotiations and potentially better plan costs.
A snapshot of stock performances among healthcare insurers further illustrates the impact of recent market and regulatory events. Over the past six months, UnitedHealth gained approximately 18.5%, while CVS rose 22.7%, though year-to-date figures show declines of 15.1% and 5.9%, respectively. Humana’s stock demonstrated a negative trend of over 24% in the past six months and more than 29% year-to-date. Variability across peers signals sector-wide uncertainty amid these regulatory headwinds.
Given the rapid pace of regulatory changes and market volatility, investors are closely monitoring developments that will shape the financial dynamics of the healthcare insurance and PBM sectors moving forward.