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.
This bill, titled the Medicines for the People Act, would create a new National Institute for Biomedical Research and Development within the Public Health Service Act. The new institute would conduct full-cycle research and development of drugs, devices, and biological products using federal laboratories, contracts with public and private entities, and acquisitions of existing technologies. Key provisions include government ownership of patents and trade secrets from institute-funded research, mandatory sharing of clinical trial data with the public, and licensing agreements that prioritize nonprofit and public entities while allowing some for-profit licensing under public interest terms. The institute would be overseen by a 15-member governing board with restrictions on members from the pharmaceutical industry, and it would receive an initial authorization of $90 billion for fiscal year 2027.
HR 1244, the "Reducing Drug Prices for Seniors Act," requires Medicare Part D plans to calculate coinsurance for covered drugs based on the plan's actual acquisition cost (the negotiated net price paid by the plan) rather than the drug's wholesale price, starting in 2026. This change directly affects Medicare Part D beneficiaries who pay coinsurance after meeting their deductible but before reaching the out-of-pocket threshold. The bill mandates that plans use the actual cost reported in the Detailed DIR Report, excluding certain drugs covered under specific exceptions. This policy aims to lower out-of-pocket costs for seniors by aligning coinsurance with the price the plan actually pays for medications.
Alternatives to Prevent Addiction In the Nation Act or the Alternatives to PAIN Act This bill reduces cost-sharing and prohibits the imposition of certain utilization requirements under the Medicare prescription drug benefit for certain non-opioid pain management drugs. Specifically, the bill requires such drugs to be covered without a deductible and to be placed on the lowest cost-sharing tier (if any). The bill also prohibits the imposition of prior authorization requirements (i.e., requiring prior approval from a plan) or step therapy requirements (i.e., requiring the use of alternative drugs before a drug is covered under a plan) with respect to such drugs.
HR 1492 amends the Social Security Act to extend the negotiation period for standard drug manufacturers under the federal drug pricing program. Specifically, it changes the timeframe from 7 years to 11 years for small-molecule drugs (like traditional pills) to negotiate prices with the government, aligning it with the existing 12-year period for complex biologic drugs (like insulin or monoclonal antibodies). This adjustment directly affects pharmaceutical companies that produce small-molecule drugs, giving them a longer window to negotiate pricing terms. The bill makes this change effective as if it had been part of the 2022 law that established the program.
