"Congress finally took action to rein in PBMs via the Consolidated Appropriations Act of 2026. It included reforms like the delinking of PBM compensation from the price of a drug in Medicare Part D and more detailed reporting to plan sponsors. But this is only the tip of the iceberg when it comes to the PBM reform that advocates are calling for."
"The Break Up Big Medicine bill would "prohibit a parent company from owning a medical provider or management services organization and a PBM or an insurer." It also takes action beyond PBMs, such as banning a parent company of a prescription drug or medical device wholesaler from owning a medical provider or management services organization."
""I think the chances of it passing are slim to none. I think the chances of it getting attention and actually starting conversations and possibly additional hearings might be likely, but I would be shocked if this got passed," said Chris Deacon, principal and founder of VerSan Consulting."
Congress enacted the Consolidated Appropriations Act of 2026 in February, implementing PBM reforms including delinking PBM compensation from drug prices in Medicare Part D and requiring detailed reporting to plan sponsors. However, advocates consider these measures insufficient and are pushing for more comprehensive reforms. The three largest PBMs are owned by major insurance companies: CVS Health's Caremark, UnitedHealth Group's Optum Rx, and Cigna's Express Scripts. Senators Elizabeth Warren and Josh Hawley introduced the Break Up Big Medicine bill in February, which would prohibit parent companies from owning both medical providers and PBMs or insurers simultaneously. Healthcare policy experts believe passage is unlikely despite potential for increased attention and congressional discussions. PBM reform efforts have faced lengthy timelines, with early transparency bills dating back to 2011.
Read at MedCity News
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