News

Lawmakers Continue to Scrutinize PBM Operations

October 26, 2026

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Lawmakers Continue to Scrutinize PBM Operations – House Oversight and Government Reform Committee Chair James Comer (R-Ky.) has sent letters to CVS Caremark, Express Scripts, and Optum Rx seeking information on the pharmacy benefit managers’ (PBM) auditing of independent pharmacies. “The committee is concerned that independent pharmacies have potentially been targeted for punitive audits in retaliation for their public support of legislation recently passed by the committee,” Comer stated. The legislation in question is the Pharmacists Fight Back Act (H.R. 6610), which was advanced by the panel in July. The bill would implement a pharmacy reimbursement model using pricing benchmarked to the National Average Drug Acquisition Cost and prohibit PBMs from patient steering.

 

In related news, Sens. Chuck Grassley (R-Iowa) and Maria Cantwell (D-Wash.) have asked the Federal Trade Commission (FTC) to complete its study on PBMs and release a final report with recommendations to Congress. The lawmakers praise the work that has been done by the FTC since the agency opened the study more than four years ago, but argue that more needs to be done to hold PBMs accountable. “Congress needs a final report to evaluate whether existing antitrust and consumer protection laws adequately address the identified conduct and whether additional legislation is warranted,” the letter states.

 

MAHA Advocate Calley Means Resigns from HHS Post – Calley Means, senior adviser to Secretary Robert F. Kennedy Jr., resigned from his position on Thursday. His resignation follows several alleged disagreements with the Trump administration on the Make America Healthy Again (MAHA) agenda. Means is a wellness entrepreneur who worked on Kennedy’s 2024 presidential campaign. He is reportedly frustrated with the lack of progress around the effort to define and eventually regulate ultra processed foods.

 

President Signs Executive Order on Women’s Health – President Donald Trump has signed an executive order entitled Advancing Women’s Health to Improve Outcomes in All Phases of Life. The order, unveiled alongside First Lady Melania Trump, establishes the White House Women’s Health Task Force and directs the U.S. Department of Health and Human Services (HHS) Secretary and the National Institutes of Health (NIH) Director to establish a Women’s Health Division within the NIH to coordinate research, address gaps in scientific understanding, and accelerate the translation of discoveries into better health outcomes. The White House Task Force, led by White House Chief of Staff Susie Wiles and HHS Secretary Robert F. Kennedy Jr., met for the first time last week.

 

NAM Announces Election of 100 New Members – The  National Academy of Medicine (NAM) announced the election of 100 new members during its annual meeting on Monday. New members include Anthony Letai, MD, PhD, director of the National Cancer Institute, Susan Monarez, PhD, former director of the Centers for Disease Control and Prevention (CDC), Daniel Jernigan, MD, MPH, former director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, and William Frist, MD, former Republican Senate majority leader. The full list of new members can be found here.

 

Senate Democrats Release Report on Medicaid Eligibility Contractors – Sens. Ron Wyden (D-Ore.), Elizabeth Warren (D-Mass.), and Raphael Warnock (D-Ga.) have released a report detailing their investigation into the contractors responsible for operating state Medicaid eligibility systems. The report found that five of the largest companies that build, operate, or support Medicaid eligibility and enrollment systems – Maximus, Gainwell, General Dynamics Information Technology, Conduent, and Deloitte – have a history “of errors that wrongfully strip health coverage from eligible Americans.” The lawmakers express concern about the impact of this track record as the companies begin implementation of the new Medicaid work requirements established by the One Big Beautiful Bill Act.

 

 

Recently Introduced Health Legislation

H.Res.1631 — Expressing support for the designation of the third week of October as “National Hunter Syndrome Awareness Week”; Sponsor: Foushee, Valerie P. [Rep.-D-NC-4]; Committees: House – Energy and Commerce

 

H.Res.1632 — Expressing support for the designation of October 17, 2026, as “National Vitiligo Awareness Day”; Sponsor: Johnson, Henry C. “Hank” [Rep.-D-GA-4]; Committees: House – Energy and Commerce

 

H.R.10840 — To direct the Comptroller General of the United States to complete a study and report on retention practices with respect to non-clinical personnel at health care facilities of the Department of Veterans Affairs; Sponsor: Bilirakis, Gus M. [Rep.-R-FL-12]; Committees: House – Veterans’ Affairs

 

H.R.10844 — To amend title XVIII of the Social Security Act to ensure equitable payments for items and services furnished by mobile stroke units under the Medicare program; Sponsor: Cohen, Steve [Rep.-D-TN-9]; Committees: House – Ways and Means; Energy and Commerce

 

H.R.10850 — To amend the Public Health Service Act to require the National Coordinator for Health Information Technology to establish a national computable-guideline framework for cancer screening recommendations, and for other purposes; Sponsor: Hinson, Ashley [Rep.-R-IA-2]; Committees: House – Energy and Commerce; Ways and Means

 

H.Res.1634 — Expressing support for the recognition of October 26, 2026, as Intersex Awareness Day, and supporting the goals and ideals of Intersex Awareness Day; Sponsor: Balint, Becca [Rep.-D-VT-At Large]; Committees: House – Energy and Commerce; Education and Workforce

 

H.R.10857 — To amend the Federal Food, Drug, and Cosmetic Act and Public Health Service Act to advance the next-generation of clinical development of novel treatments and cures, and for other purposes; Sponsor: Auchincloss, Jake [Rep.-D-MA-4]; Committees: House – Energy and Commerce; Ways and Means

 

H.R.10858 — To establish the National Blood Cancer Program, and for other purposes; Sponsor: Barragán, Nanette Diaz [Rep.-D-CA-44]; Committees: House – Energy and Commerce

 

H.R.10859 — To amend title 10, United States Code, to require the Secretary of Defense to develop a strategy with respect to threats posed by the biotechnology capabilities of foreign adversaries, and for other purposes; Sponsor: Biggs, Sheri [Rep.-R-SC-3]; Committees: House – Armed Services; Intelligence (Permanent Select)

 

H.R.10862 — To direct the Inspector General of the Department of Defense to conduct a review of the efforts by the military departments to prevent incidents of deaths by suicide, suicide attempts, and suicidal ideation among members of the Armed Forces; Sponsor: Cisneros, Gilbert Ray [Rep.-D-CA-31]; Committees: House – Armed Services

 

H.R.10874 — To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in the Commonwealth of Puerto Rico or another territory of the United States; Sponsor: Hernández, Pablo Jose [Resident Commissioner-D-PR-At Large]; Committees: House – Energy and Commerce; Ways and Means

 

H.R.10875 — To amend titles II and XVIII of the Social Security Act to lower the Medicare eligibility age to 50, and for other purposes; Sponsor: Jayapal, Pramila [Rep.-D-WA-7]; Committees: House – Energy and Commerce; Ways and Means

 

H.R.10876 — To amend title XVIII of the Social Security Act to ensure appropriate access to mental health care under the Medicare program; Sponsor: Kelly, Mike [Rep.-R-PA-16]; Committees: House – Ways and Means; Energy and Commerce

 

H.R.10882 — To amend title 38, United States Code, to provide for a presumption of service-connection for male breast cancer occurring in certain veterans for purposes of determining eligibility for disability compensation under the laws administered by the Secretary of Veterans Affairs; Sponsor: Larsen, Rick [Rep.-D-WA-2]; Committees: House – Veterans’ Affairs

 

H.R.10884 — To provide additional options on certain federal application forms to allow an individual to elect to be an organ donor and for other purposes; Sponsor: Lawler, Michael [Rep.-R-NY-17]; Committees: House – Ways and Means; Energy and Commerce; Veterans’ Affairs; Foreign Affairs

 

H.R.10887 — To prohibit brand name drug manufacturers from compensating generic drug manufacturers to delay the entry of a generic drug into the market, to prohibit biological product manufacturers from compensating biosimilar and interchangeable product manufacturers to delay entry of biosimilar and interchangeable products, and for other purposes; Sponsor: Magaziner, Seth [Rep.-D-RI-2]; Committees: House – Energy and Commerce; Judiciary