News Archive

"Tucked within the Consolidated Appropriations Act, 2026 (HR 7148), signed on February 3, 2026, are structural mandates that will reshape Pharmacy Benefit Manager (PBM) operations in Medicare Part D and the commercial sector by 2028. The legislation targets three primary pillars: revenue delinking, rebate transparency, and pharmacy network equity."  MORE >>

"In addition to no formal meetings, there was 'no correspondence, no communications, no nothing' in 2025. Multiple members inquired about the status of the EAC in 2025 and none of those inquiries were answered ... The website for the Council confirms there was no output for 2025 and lists no nominees or an agenda for 2026."  MORE >>

Video of Feb. 11 hearing, with testimony by: [1] Lori M. Reilly, Esq., PhRMA; [2] John F. Crowley, Biotechnology Innovation Organization; [3] John Murphy, Association for Accessible Medicines; [4] David Marin, Pharmaceutical Care Management Association; [5] Angie Boliver, Healthcare Supply Chain Association; [6] Chester "Chip" Davis, Jr., Healthcare Distribution Alliance; [7] James Gelfand, The ERISA Industry Committee; [8] Douglas Hoey, National Community Pharmacists Association.  MORE >>

"The brief urges the Court to allow the plaintiff's case to proceed by rejecting the defendant's motion to dismiss.... The suit ... alleges the defendants illegally exploited the IDR system by overwhelming the IDR process with hundreds of disputes they knew were ineligible, resulting in millions of dollars in improperly obtained awards. Plaintiffs' claims include violations of [ERISA, RICO], California's Unfair Competition Law, and common law fraud." [Anthem Blue Cross v. Halomd, No. 25-1467 (C.D. Calif. amicus brief filed Feb. 6, 2026)]  MORE >>

"[The authors] summarize economic projections of moving to a single-payer health care system and look at how they compare with proposed federal cuts, based on analyses of the New York Health Act (NYHA) (A1466/S3425), a universal public health coverage bill in front of the New York State Legislature. [They] also outline how state plans such as the NYHA could avoid the need for federal waivers and explain why now is an especially important time for state-based reform."  MORE >>

"The problem isn't the DTC model. It's the assumption that the federal government needs to run it.... If the administration wants to expand direct-to-consumer drug purchasing, the most effective role it can play is not to build a federal platform but to eliminate policy barriers that hinder private actors from competing, innovating, and lowering prices on their own."  MORE >>

"[T]he CAA includes several reforms to the pharmacy benefit manager (PBM) industry that represent a major step forward for meaningful health care reform. The PBM provisions included in the final legislation help shine a light on PBM business practices, promote transparency, and ensure that negotiated savings benefit plan sponsors and patients -- not middlemen."  MORE >>

"Within this legislative package, at least two sections stand out as game-changing provisions: [1] Sec. 6223: Assuring pharmacy access and choice for Medicare beneficiaries, and [2] Sec. 6224: Modernizing and ensuring PBM accountability."  MORE >>

Video of Jan. 22 hearing with insurance company executives. Testimony from: [1] Stephen Hemsley, UnitedHealth Group; [2] David Joyner, CVS Health; [3] Gail Boudreaux, Elevance Health; [4] David Cordani, The Cigna Group; [5] Paul Markovich, Ascendiun; and [6] Ellen Allen, West Virginians for Affordable Health Care.

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"Trump's proposal would send the value of the now-lapsed ACA enhanced subsidies directly to consumers rather than route the tax credits through their insurer to bring down premiums.... [T]he plan aims to 'hold big insurance companies accountable' by requiring that they post rate and coverage comparisons online in plain English, making it easier for consumers to shop for coverage. It would also require that health plans publish what percentage of their revenue is paid out to claims compared to overhead costs and profits."  MORE >>

"The [ERISA Litigation Reform Act (HR 6084)] would impose a stay on discovery once a defendant files a motion to dismiss under Rule 12 in any action against a plan or its fiduciaries under Section 502. The stay would be automatic unless the court finds that particularized discovery is necessary to preserve evidence or prevent undue prejudice. The bill would also impose document preservation obligations during the pendency of the stay."  MORE >>

"If the president and Congress follow through on the promise to shift more prescription drugs to pharmacies' over-the-counter sections, they will make medicines cheaper and more accessible -- but, more importantly, they will return a measure of control over health care to patients themselves, where it belongs."  MORE >>

"President Donald J. Trump's Great Healthcare Plan is a broad healthcare initiative that will slash prescription drug prices, reduce insurance premiums, hold big insurance companies accountable, and maximize price transparency in the American healthcare system." [Also available: White House Fact Sheet]  MORE >>

"The Great Healthcare Plan [1] calls for codifying the Trump Administration's Most-Favored-Nation deals to get Americans the same low prices for prescription drugs that people in other countries pay.... [2] funds a cost-sharing reduction program for healthcare plans which would save taxpayers at least $36 billion ... [3] will end the kickbacks paid by pharmacy benefit managers (PBMs) to the large brokerage middlemen ... [4] [creates] the 'Plain English' insurance standard and [requires] insurance companies to prominently post the profits they take out of premiums as well as information on the frequency with which they deny care ... [5] requires any healthcare provider or insurer who accepts Medicare or Medicaid to prominently post their pricing and fees in their place of business[.]"  MORE >>

"PTC opponents have pushed false claims to advocate against extending the enhancements. But as policymakers continue to negotiate an extension to help the millions of people who are seeing their premium costs spike, they should keep the realities of PTCs in mind."  MORE >>

"Ways and Means Committee Chairman Jason Smith (MO-08) and Energy and Commerce Committee Chairman Brett Guthrie (KY-02) announced the details for an upcoming hearing with five of the biggest health insurance company CEOs to answer questions on making health care more affordable for all Americans.... The date of the hearing will be January 22, 2025 ... Company CEOs in attendance will be UnitedHealth Group, CVS Health, Elevance Health, The Cigna Group, and Ascendiun (the parent company of Blue Shield of California)."  MORE >>

"[T]wo air ambulance providers ... have filed a petition for writ of certiorari with the U.S. Supreme Court ... The petition asks the Court to decide a key question that has divided federal courts across the country: whether the NSA permits providers to bring private causes of action to enforce IDR awards in court. Should the Supreme Court grant cert, the outcome of the case could have broad implications for the enforceability of NSA arbitration awards, a key feature of the NSA's regulatory framework." [Guardian Flight, L.L.C. and Med-Trans Corp. v. Health Care Serv. Corp., No. 24-10561 (5th Cir. June 12, 2025; cert. pet. filed Oct. 8, 2025, No. 25-441)]  MORE >>

19 pages. "The need for long-term reforms to Medicare has been repeatedly raised. One is to raise the eligibility age from 65 to the Social Security full retirement age of 67, then tie it to increases in longevity.... In this paper, [the authors] estimate the coverage and spending effects of eliminating Medicare coverage for those ages 65 to 66[.]"  MORE >>

"This brief provides an overview of the role of PBMs in managing pharmacy benefits, discusses recent federal legislation focusing on several elements of PBM business practices, and explains the potential federal budgetary impact of this legislation, which would have a relatively modest impact on the federal deficit, based on available CBO estimates."  MORE >>

"[T]he Fifth Circuit reversed an award of more than $1.8 million in attorneys' fees under ERISA Section 502(g)(1), holding that a claimant who ultimately obtained no substantive relief cannot recover fees based solely on favorable factual findings or judicial criticism of plan procedures." [Cloud v. Bert Bell/Pete Rozelle NFL Player Ret. Plan, No. 25-10337 (5th Cir. Dec. 18, 2025),]  MORE >>

"In the latest survey of leading health care policy scholars ... [most] agreed that proposals to convert enhanced subsidies for [ACA] Marketplace plans into contributions for health savings accounts (HSAs) would have an overall effect of worsening health care affordability for enrollees. There was also consensus that requiring small-dollar premiums (instead of permitting fully subsidized plans with no net premium) would measurably reduce Marketplace enrollment; there was further consensus that a scheduled policy change that will effectively end automatic renewals with subsidy will substantially reduce Marketplace enrollment."  MORE >>

"First and foremost is the role that health care affordability will play in the midterms.... Second ... how enrollees actually respond in the Marketplaces.... [S]tates that have expanded Medicaid will be gearing up for Medicaid work requirements, which kick in in 2027 ... [A]fter years of moderate increases ... health costs will increase more sharply again.... [T]he Trump administration has put pressure on drug prices through a variety of initiatives.... [F]our in 10 Americans say they identify in some way with the MAHA agenda."  MORE >>

"[Some] are pitching the accounts as an alternative to expiring enhanced federal subsidies that have lowered insurance premium payments for most Americans with [ACA] coverage. But legal limits on how HSAs can and can't be used are prompting doubts that expanding their use would benefit the predominantly low-income people who rely on ACA plans.... One group that would almost certainly benefit: a slew of companies selling expensive wellness items that can be purchased with tax-free dollars from the accounts."  MORE >>

"[M]aking patients bear more of their costs out of pocket is a bad way to reduce wasteful health-care spending. It does more to inhibit access to care than to steer patients to cheaper sources of treatment. This is because health-care spending is highly concentrated among the seriously ill, for whom additional expenditures greatly exceed any realistic deductibles. Legislators should instead focus on letting Americans purchase more affordable insurance plans that are better focused on their health needs."  MORE >>

December 3 hearing.  Video and testimony from witnesses [1] Joel White, Council for Affordable Health Coverage; [2] Marcie Strouse, Capitol Benefits Group; and [3] Claudia M. Fegan, MD, Physicians for a National Health Program.  MORE >>