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.
This non-binding resolution expresses the House of Representatives' view that the FDA should regulate mifepristone, a medication used for abortion, based on scientific evidence rather than political pressure. It highlights over 25 years of data showing the drug is safe and effective when prescribed via telemedicine or dispensed by mail and pharmacy. The bill advocates for policies that ensure equitable access to this care, particularly for marginalized communities facing barriers due to state-level restrictions. By citing numerous studies and medical organizations, the resolution calls for transparent, science-based decisions to maintain current access methods.
Ensuring Access to Lower-Cost Medicines for Seniors Act This bill requires prescription drug plans under the Medicare prescription drug benefit to include generic drugs and biosimilars on their formularies. Specifically, the bill requires plans that use formularies to include generic drugs and biosimilars on the formularies and without any requirements (e.g., prior authorization requirements) that are more restrictive as compared to those for brand-name drugs and biologics. Plans that use cost-sharing tiers must also have specific tiers for generic drugs and biosimilars, in accordance with certain limitations.
The Every Dollar Counts Act of 2026 requires health insurance plans and issuers to count money spent by individuals on prescription drugs purchased directly, without applying their insurance benefits, towards their annual deductible and out-of-pocket maximums. This means that if an individual pays cash for a drug or uses a discount card instead of their insurance benefits, those expenditures will still contribute to reaching their yearly healthcare spending limits. This change directly affects individuals enrolled in group or individual health insurance coverage. The new rules will take effect for plan years beginning on or after January 1, 2027.
This bill prohibits pharmacy benefit management companies from paying referral fees to brokers, consultants, or other individuals in exchange for directing business to them. It directly affects pharmacy benefit management service providers, brokerage firms, and healthcare plans by amending the Employee Retirement Income Security Act to ban such compensation arrangements. The key provision adds a new restriction to existing laws, making it illegal for these service providers to pay any amount, directly or indirectly, for referrals of their services. The ban takes effect for plan years starting after the bill is enacted, aiming to increase transparency in healthcare service contracting.
This bill requires Medicare Part D prescription drug plans to include certain lower-cost generic drugs and biosimilar biological products in preferred positions on their formularies starting in 2027. It mandates that these lower-cost alternatives be placed on more favorable tiers with reduced out-of-pocket costs compared to their brand-name counterparts. Additionally, the legislation prohibits plans from imposing stricter access restrictions, such as prior authorization or step therapy, on these lower-cost options than those applied to the original brand-name drugs. The measure directly affects Medicare beneficiaries enrolled in Part D plans and the insurance sponsors who manage those formularies.
The INSULIN Act of 2026 requires health insurance plans to limit insulin copayments to $35 per 30-day supply starting in 2027, with plans choosing to cap costs at 25% of the negotiated price after 2028. The bill also mandates that pharmacy benefit managers pass all rebates and discounts related to insulin directly to health plans rather than retaining them. Additional provisions include measures to speed up the approval process for generic and biosimilar insulin products, establish a pilot program to provide affordable insulin to uninsured individuals in 10 states, and create a resource center and hotline to help uninsured people access assistance programs.
This bill, titled the Healthy Competition for Better Care Act, prohibits health insurance companies and group health plans from entering into contracts with healthcare providers that include certain anticompetitive restrictions. Specifically, it bans agreements that prevent insurers from steering patients toward different providers, require insurers to make additional agreements with related entities, force payment rate agreements with affiliates not involved in the contract, or stop other insurers from paying lower rates for the same services. The law includes exceptions for certain types of healthcare networks like health maintenance organizations and value-based care arrangements, allows states to grandfather existing contracts for up to 10 years if they are unlikely to reduce competition, and requires federal agencies to create implementing regulations within one year of enactment.
This bill, known as the Rx ACCESS Act, aims to improve medication access for military beneficiaries enrolled in the TRICARE health program by allowing them to choose how they receive non-generic prescription maintenance medications starting in October 2026. It requires pharmacy benefit managers to reimburse retail pharmacies at least the actual cost of acquiring drugs plus a professional dispensing fee, and prohibits hidden fees on pharmacies. The bill also mandates annual audits by the Government Accountability Office to review reimbursement rates, pharmacy network adequacy, and beneficiary access, with results reported to congressional defense committees.
This bill, known as the DIABETES Act, aims to improve Medicare coverage for diabetes technology and education services. It would require Medicare to continue covering diabetes devices like continuous glucose monitors and insulin pumps when beneficiaries enroll in the program, preventing loss of access during enrollment transitions. The legislation also expands coverage for diabetes self-management training services, removes deductibles for these services, and authorizes virtual training options. Additionally, it directs the government to study barriers to diabetes care access and establish new billing codes for insulin pump training services.
