The Fair Care Act of 2026 is a comprehensive legislative proposal designed to lower health care costs and improve access by modernizing health savings accounts, expanding insurance coverage options, and increasing transparency in the health care market. The bill directly affects individuals, employers, health insurance issuers, hospitals, and pharmaceutical manufacturers through provisions that allow unused premium tax credits to be deposited into savings accounts, introduce new "copper" insurance plans, and require greater price transparency for hospitals and pharmacy benefit managers. Key mechanisms include the repeal of the employer health insurance mandate, the establishment of a federal reinsurance pool for high-risk individuals, the creation of a conditional approval pathway for drugs treating rare and serious diseases, and the imposition of congressional review procedures for major Food and Drug Administration rules. Additionally, the legislation seeks to promote competition by banning anticompetitive contract terms, regulating co-pay contributions from drug manufacturers, and enforcing stricter price reporting requirements for shoppable medical procedures.
The Access to Innovative Treatments Act of 2026 changes how Medicare reviews decisions to deny or limit coverage for new drugs and biological products. It requires the Medicare administrator to start a review within 90 days of a request, includes a 30-day period for public comments, and mandates a final decision within 120 days that must address those comments. The bill also prevents Medicare from applying old coverage rules to newly approved or licensed drugs if those rules would contradict the current approval. Additionally, it stops prescription drug plans from using outdated coverage decisions to deny payment for new medications. These changes directly affect Medicare beneficiaries, drug manufacturers, and the Medicare program administrators.
The Prior Authorization Reform for Autoimmune and Blood Disorders Act requires group health plans and health insurers to cover specific medications for autoimmune diseases, hemophilia, and Von Willebrand disease without restricting how they are administered. To improve access, the bill limits prior authorization requirements for these drugs to no more than once every 12 months, unless the medication is short-term, classified as an opioid or benzodiazepine, or carries a specific government-mandated risk management strategy. These rules apply to plans governed by federal laws including ERISA, the Public Health Service Act, and the Internal Revenue Code, with coverage beginning for plan years starting on or after January 1, 2027.
This bill creates a new federal commission to set maximum prices for all approved prescription drugs, including insulin and vaccines, starting in 2027. The commission would determine these "fair prices" by considering manufacturing costs, therapeutic benefits, and prices in other countries, while the Health and Human Services Secretary would publish the final prices that drug makers must charge. Manufacturers that sell drugs above these set prices would face significant fines, and the bill grants the government the authority to bypass patent protections to increase drug production if domestic supply is insufficient.
The Medication Competition Act requires the Food and Drug Administration to publish specific expiration dates for legal protections on biological drugs. This rule applies to both new drugs approved after the law passes and older drugs that received protection before the law was enacted. By making these timelines public, the bill aims to help generic drug makers know exactly when they can start selling their own versions of these medicines. The change does not alter the length of the protection periods themselves but increases transparency regarding when those periods end.
The MISSION Rx Act ensures that military beneficiaries and veterans pay no more for specific negotiated drugs than Medicare Part D beneficiaries do. It achieves this by capping the out-of-pocket costs for TRICARE-covered servicemembers and copayments for veterans at the same levels established under the federal drug price negotiation program. Additionally, the bill requires federal agencies to limit the maximum prices they agree to pay pharmaceutical manufacturers for these same negotiated drugs. These changes apply to existing contracts and new agreements involving drugs selected for federal price negotiation.
The Patients Before Monopolies Act aims to break up large health care companies that currently own both insurance or pharmacy benefit management services and physical pharmacies. It directly affects major health care conglomerates by making it illegal for them to own pharmacies while also managing drug pricing or insurance, requiring them to sell off their pharmacy operations within one year. The bill empowers federal agencies like the FTC and the Department of Justice to enforce these rules, impose financial penalties for non-compliance, and block future mergers that would recreate these conflicts of interest.
The Drug Deal Disclosure Act requires the Department of Health and Human Services to publicly release specific records regarding agreements between the federal government and major drug manufacturers starting in 2025. This law mandates the disclosure of contracts that include provisions such as reduced drug prices based on international rates, direct-to-consumer sales discounts, duty exemptions, and special treatment for Medicare programs. While the bill allows for the redaction of confidential pricing details, it prohibits withholding information based on political sensitivity or reputational harm and requires a detailed justification for any redactions. Additionally, the act mandates reports to Congress and independent analysis from the Congressional Budget Office and the Government Accountability Office to evaluate the economic and budgetary impacts of these agreements.
The Affordable Insulin Now Act of 2026 mandates that private health plans, including those under Medicare, ERISA, and the Internal Revenue Code, cover specific insulin products starting in 2027 without applying deductibles. For these covered insulins, the law limits patient out-of-pocket costs to the lesser of $35 per 30-day supply or 25% of the negotiated price, while also counting these payments toward annual deductibles and out-of-pocket maximums. The legislation defines "selected insulin products" to include at least one dosage form of each type available, such as rapid-acting or long-acting varieties, but does not require coverage for insulins outside this selection. Additionally, the bill establishes a program to reimburse healthcare providers and pharmacies up to $35 for insulin dispensed to uninsured individuals, ensuring they do not hold the patients liable for the cost.
The Patients Before Monopolies Act prohibits companies from owning both pharmacy benefit managers and insurance businesses or pharmacies to eliminate conflicts of interest. It requires existing violators to sell off their pharmacy operations within one year and grants the Federal Trade Commission and Department of Justice the power to block new mergers that would recreate these combined ownership structures. The bill also allows private citizens and state officials to sue for violations, seeking penalties like disgorgement of profits and treble damages if the law is broken.
