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June 10, 2026

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legislation

Bicameral Patients before Monopolies Act reintroduced

On May 13, bipartisan lawmakers in the House and Senate reintroduced the Patients Before Monopolies (PBM) Act (S.4509/H.R.8779), legislation that would prohibit common ownership of PBMs, insurers, and pharmacies. Sponsored by Sens. Warren (D-MA) and Josh Hawley (R-MO) alongside Reps. Diana Harshbarger (R-TN) and Jake Auchincloss (D-MA), the bill would require impacted organizations to divest […]
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June 10, 2026

EGWP marketplace medicaid Medicare

legislation

CMS announces ePA acceleration initiative, democrats seek to repeal WISeR Model

The Centers for Medicare & Medicaid Services (CMS) is advancing its electronic prior authorization (ePA) efforts through a newly established Electronic Prior Authorization Acceleration initiative to address key challenges and drive solutions ahead of 2027 requirements. To date, 29 health care organizations – including health systems, electronic health record developers, physician practices, networks, and digital health […]
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June 10, 2026

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legislation

Tri-Departments release fertility excepted benefits proposed rule

On May 10, the Departments of Labor, HHS, and Treasury (the Departments) issued a proposed rule that would create a new category of limited excepted benefits to allow employers to offer stand-alone fertility benefits to their employees, similar to dental, vision, and other supplemental coverage. Benefits would be limited to fertility-related items and services for […]
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June 10, 2026

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Initiatives

PCMA launches new affordability campaign

PCMA rolled out a new seven-figure multi-channel advertising campaign focused on affordability. The campaign, which has been covered by Bloomberg, Inside Health Policy, and Politico, will include digital, email, and streaming advertising, events, podcasts, a new microsite, and a suite of resources designed to better explain how PBMs work and the outsized value they deliver […]
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June 10, 2026

EGWP marketplace medicaid Medicare

Solutions

PCMA asks DOJ and FTC to investigate role of wholesalers in generic drug prices

On May 21, PCMA submitted comments to the Department of Justice (DOJ) Antitrust Division and the Federal Trade Commission (FTC) encouraging them to seek information about the business practices of drug wholesalers. The comments were submitted in response to an earlier request for public comments about reinstating guidelines for business collaborations. The comments highlight that the […]
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June 10, 2026

EGWP marketplace medicaid Medicare

perspectives

Americans continue to be satisfied with employer-sponsored coverage

A new national survey commissioned by AHIP finds American workers hold consistently positive views of employer-sponsored health coverage, with nearly 9 in 10 expressing satisfaction with their plans and a decisive 96% valuing the financial security their coverage provides. Workers view employer-provided coverage as integral to their employment decisions, with 68% ranking health insurance as […]
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April 15, 2026

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Solutions

AHIP and BCBSA provide progress update on prior authorization commitments

On April 7, The Cigna Group joined other health plans in announcing an update on the industry’s progress implementing the voluntary prior authorization commitments made in partnership with the Department of Health and Human Services and CMS last year. Since June 2025, participating health plans have eliminated 11% of prior authorizations across a range of […]
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April 15, 2026

EGWP marketplace medicaid Medicare

Solutions

Navigating AI’s rapid change together: A health plan partnership approach

Artificial intelligence (AI) is rapidly transforming how we interact with the world around us – whether through our phones, at the doctor’s office or even the workplace – it is a technology poised to reshape industries in unimaginable ways. Within our industry, however, the future of AI is nuanced with additional factors – shifting member […]
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April 15, 2026

EGWP marketplace medicaid Medicare