119th Congress Continues Momentum on PBM Reform

April 9, 2025

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Both chambers of Congress are pressing forward with PBM reform efforts, reintroducing several bills that stalled in the last session. Sens. Chuck Grassley (R-IA) and Maria Cantwell (D-WA) reintroduced their bipartisan proposals to address transparency and drug pricing concerns: the Prescription Pricing for the People Act would require a federal study of industry consolidation and pricing practices, while the Pharmacy Benefit Manager Transparency Actwould ban claw backs of payments made to pharmacies and expand the Federal Trade Commission’s authority to regulate PBM business practices.

Separately, Sen. Dick Durbin (D-IL) reintroduced the Drug-price Transparency for Consumers (DTC) Act, which would require disclosure of prescription drug costs in direct-to-consumer advertising. In the House, lawmakers have revived measures like the Saving Seniors on Prescriptions Act, which would implement reporting requirements for PBMs under Medicare Part D and Medicare Advantage.

While more popular legislative proposals – including the Lower Costs, More Transparency Act – have yet to be resurrected, these early reintroductions are indicative of bipartisan support to move forward with PBM reforms this year.

legislation

CMS Releases Final 2026 MA Policy and Technical Rule; Declines to Finalize Coverage of GLP-1s

On April 4, the Centers for Medicare & Medicaid Services (CMS) finalized the 2026 MA Policy and Technical Changes rule. Of note, CMS is not finalizing certain provisions from the proposed rule, most importantly the proposal requiring coverage of anti-obesity medications (AOMs) in both Medicare and Medicaid. CMS said that it may address these proposals […]
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April 9, 2025

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legislation

Budget Reconciliation Process Continues with Senate Consideration of Revised House Resolution

On April 5, the Senate voted 51-48 to pass a modified version of the House-passed budget resolution with reduced deficit reduction targets for Senate committees as compared to the House. Specific to health care, the revised Senate resolution instructs the Senate Finance Committee (SFC), which has jurisdiction over Medicaid, to propose changes that will increase […]
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April 9, 2025

medicaid

legislation

2026 Final Rate Announcement for MA and Final Part D Program Instructions

On April 7, CMS released the Calendar Year (CY) 2026 MA and Part D Final Rate Announcement and the Final CY 2026 Medicare Part D Program Instructions. The Administration strongly defended its focus on fraud, waste, and abuse, while protecting beneficiaries. The final rate notice increases average payments to MA plans by 5.06% up from […]
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April 9, 2025

EGWP medicaid Medicare

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