Bicameral Patients before Monopolies Act reintroduced

June 10, 2026

EGWP marketplace medicaid Medicare

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 pharmacy assets within one year of enactment.

The reintroduced PBM Act includes more aggressive implementation and enforcement provisions than prior iterations, including a shortened one-year divestiture timeline and financial penalties tied to noncompliance.

The reintroduction reflects continued Congressional focus on PBM-related reforms and populist push to curb health care consolidation – particularly targeting vertically integrated models – despite significant PBM reforms being recently enacted as part of the Consolidated Appropriations Act, 2026 (CAA).

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 […]
read more >

June 10, 2026

EGWP marketplace medicaid Medicare

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 […]
read more >

June 10, 2026

marketplace medicaid

legislation

Massachusetts issues final prior authorization rule

The Massachusetts Division of Insurance (DOI) has finalized its prior authorization regulations, which went into effect on June 5. Implementation will be phased, with the DOI indicating that additional guidance will be issued through educational sessions planned throughout June. Carriers must submit implementation plans by September. The regulations will prohibit prior authorization for several services, including […]
read more >

June 10, 2026

EGWP marketplace medicaid Medicare

You may also like