Monthly Legislative & Lobbying Activity Report for June 2026
Legislative Activity
PBM Transparency and TRICARE Pharmacy Language Advance in June
In June, lawmakers continued to advance PBM and health care transparency legislation, with activity focused primarily on commercial market transparency, employer access to claims and payment data, spread pricing disclosure, and oversight of the TRICARE pharmacy benefit.
- Clear Healthcare Expense Cost Knowledge Act, or CHECK Act (R. 9117). On June 3, Rep. Nick Langworthy (R-NY) introduced H.R. 9117, the CHECK Act. The bill is primarily a health care transparency measure aimed at giving employers, health plans, and patients a clearer view into health care costs and payment flows. With respect to PBMs, the bill would require PBMs, third-party administrators, provider networks, and other health care middlemen to provide quarterly disclosures to health plans regarding claims, reimbursements, pricing, fees, rebates, and other payment arrangements. The bill would also prohibit contractual gag clauses that prevent employers and plan sponsors from accessing information needed to evaluate PBM and vendor performance.
- Lower Costs, More Transparency Act (R. 9393). On June 23, House Energy and Commerce Committee Chairman Brett Guthrie (R-KY) and Ranking Member Frank Pallone (D-NJ) introduced H.R. 9393, the Lower Costs, More Transparency Act. On June 25, the bill was advanced by voice vote by the House Energy and Commerce Health Subcommittee and then by the full Energy and Commerce Committee.
The bill includes provisions addressing PBM spread pricing in the commercial market. Specifically, it would require PBMs serving group health plans and group or individual health insurance coverage to disclose drugs subject to spread pricing, identified by National Drug Code and contracted pharmacy. These provisions appear to apply to commercial coverage, including employer-sponsored plans and individual-market coverage, rather than Medicare or Medicaid. Among other things, the bill would require plans and issuers to identify applicable spread price drugs in participant-facing cost-sharing tools; disclose the difference between what the PBM pays the pharmacy and what the plan or issuer pays the PBM; and provide a plain-language explanation of spread pricing and its potential impact on plan payments and patient cost sharing.
The bill would also require public reporting of drug payment information, including in-network rates and average plan payments, with average payments accounting for rebates, discounts, price concessions, and other remuneration specified by the Secretary. For spread-priced drugs, public files would have to flag the drug and disclose the spread amount for each contracted pharmacy. In addition, PBMs would be required to provide plans and issuers with the information necessary to make these consumer-facing and public-facing disclosures timely and accurate.
- TRICARE PBM Audit Language in FY2027 NDAA. In June, Congress advanced TRICARE pharmacy benefit transparency language in both the House and Senate versions of the FY2027 National Defense Authorization Act (NDAA). The provisions would require a GAO audit of the TRICARE Pharmacy Benefits Program and force greater visibility into reimbursement, spread, price concessions, affiliated-pharmacy issues, and network adequacy.
The language in both chambers is based on the Rx Access, Choice, Cost Equity, and Supply Stability Act (ACCESS) Act, led in the House by Rep. Jen Kiggans as H.R. 6400 and in the Senate by Sen. Tom Cotton as S. 4106. The Rx ACCESS Act is designed to improve prescription drug access and transparency for military families and seniors and has been a key legislative framework for addressing TRICARE pharmacy benefit concerns, including Express Scripts’ role as the Cigna-owned PBM administering the TRICARE pharmacy benefit.
On the House side, H.R. 8800, the FY2027 NDAA, was introduced on May 13 and referred to the House Armed Services Committee. During the committee’s June 4 markup, Rep. Kiggans’ TRICARE pharmacy audit language was added through the Military Personnel en bloc package. The provision was included in the House-reported bill as Section 774, “Assessment of Access, Fairness, and Transparency Under TRICARE Pharmacy Benefits Program.” The House Armed Services Committee ordered the bill reported, as amended, by a vote of 44-12.
The House provision would require GAO to audit the TRICARE Pharmacy Benefits Program, including reimbursement rates, price concessions, reimbursement discrepancies across retail, mail-order, specialty, and contractor-affiliated pharmacies, spread between amounts charged to TRICARE and amounts paid to pharmacies, prior authorization practices, dispensing timeliness, and retail pharmacy network adequacy. It would also require the TRICARE pharmacy benefit contractor to provide GAO with claims-level data, reimbursement methodologies, payment rates, price concessions, and relevant contracts or subcontracts.
On the Senate side, the Senate Armed Services Committee completed markup of its FY2027 NDAA on June 11, voting 18-9 to advance the bill to the Senate floor. The Senate version, S. 4784, was filed on June 16 and includes parallel TRICARE pharmacy audit language as Section 769, using the same title as the House provision: Assessment of Access, Fairness, and Transparency Under TRICARE Pharmacy Benefits Program.
The Senate language is similar to the House version but includes several stronger provisions. It requires an initial GAO audit within one year of enactment and a second audit within one year after the first new TRICARE pharmacy benefit contract takes effect. It also more expressly references direct and indirect remuneration fees, bonuses, and clawbacks; treats a contractor’s failure to provide required information to GAO as a material breach of contract; requires DoD to modify existing contracts within 90 days as needed to ensure compliance; and prohibits DoD from extending or renewing an existing TRICARE pharmacy benefit contract unless the contractor is in full compliance.
As of the end of June, both chambers had included TRICARE PBM audit language in their respective NDAA vehicles. The House bill was reported by the House Armed Services Committee, but floor consideration stalled on June 30, when the rule for H.R. 8800 failed by a vote of 198-224. The Senate bill, S. 4784, was reported by the Senate Armed Services Committee on June 15, placed on the Senate Legislative Calendar as Calendar No. 436, and is awaiting further floor action.
The inclusion of Rx ACCESS-based language in both chambers gives supporters a meaningful foundation to preserve the provision in the final FY2027 NDAA. However, the provision is not yet law and could still change during floor consideration, conference, or final negotiations.
- Senate Finance Committee Request for Information. On June 16, Senate Finance Committee Ranking Member Ron Wyden (D-OR) issued a request for information on proposed policies aimed at lowering prescription drug costs, including policies to address perverse incentives that encourage middlemen to raise costs for patients. Public comments are due to the Committee by August 17. While the RFI does not itself advance legislation, it is another marker of continued Senate Democratic interest in prescription drug affordability and PBM-related incentives. It may also help shape future Democratic messaging and legislative proposals heading into the next Congress.
Hearings
- House Energy and Commerce Health Subcommittee Hearing on Health Care Transparency. On June 10, the House Energy and Commerce Health Subcommittee held a hearing titled “Lowering Health Care Costs for All Americans: Examining Policies to Increase Health Care Transparency.” Although the hearing was not principally a PBM reform hearing, PBM-related issues came up repeatedly through broader discussions of employer access to claims data, rebates, vertical integration, medical loss ratio transparency, NADAC and drug acquisition cost reporting, 340B, and the need to “follow the money” across the health care system. Key themes included:
- Employers need access to claims data to understand what they are actually paying.
- PBM and insurer vertical integration raises concerns about money being shifted within affiliated entities.
- MLR rules may not capture how vertically integrated companies move premium dollars through affiliated PBMs, pharmacies, providers, and other entities.
- Drug pricing transparency, including NADAC reporting, is important for understanding pharmacy reimbursement and patient costs.
- Rebates and 340B-related discounts remain opaque, and employers may be losing discounts without being able to track the financial impact.
- Witnesses generally supported stronger transparency, codification, and enforcement, while also making clear that transparency alone will not lower costs without competition and additional reforms.
Several exchanges were particularly relevant to PBM reform:
- Carol Skenes of Turquoise Health urged Congress to pass legislation such as the Lower Costs, More Transparency Act and the Patients Deserve Price Tags Act, noting that such bills could codify existing machine-readable file requirements, extend transparency obligations to non-hospital providers, and mandate drug price reporting, self-pay reporting, stop-loss disclosure, and uniform schema standards. While not framed as PBM reform directly, her testimony is relevant because it supports broader transparency into prescription drug pricing and payment methodologies.
- Chairman Brett Guthrie (R-KY) raised concerns about rebate arrangements and health care middlemen. He described a scenario in which Congress intended rebates to flow to the customer, but an insurer-created group purchasing organization became the “customer,” allowing rebates to flow to the affiliated entity rather than to the intended beneficiary. Guthrie argued that every time Congress tries to make the benefit flow to consumers, the money seems to “pop up somewhere else.”
- Shawn Gremminger, President and CEO of the National Alliance of Healthcare Purchaser Coalitions, responded that employers need access to their own claims data so they can understand what they actually paid. He also emphasized the need for competition, warning that if employers only have a couple of large PBMs to negotiate with, they may simply be trading one bad deal for another.
- Kim Schrier (D-WA) discussed UnitedHealth Group and Optum as an example of vertical integration. She noted that UnitedHealth’s CEO had previously told the Committee that owning clinics, doctors, PBMs, and pharmacies drives down prices. She asked Dr. Christopher Whaley whether there was evidence to support that claim. Whaley answered, “We’ve seen no evidence that that’s the case.” The exchange directly tied PBM ownership to the broader vertical integration concerns now receiving increased scrutiny in Congress.
- Kat Cammack (R-FL) raised medical loss ratio transparency and concerns that vertically integrated insurers can satisfy MLR requirements on paper while moving money among affiliated PBMs, pharmacies, provider groups, and other entities. She asked the witness panel whether consumers currently have enough transparency to know whether premium dollars are actually funding care or simply being transferred between affiliated entities. The witnesses who answered all said no. This was one of the clearest PBM-relevant exchanges of the hearing, as it tied PBM ownership to insurer accounting, premium dollars, and potential gaming of MLR rules.
- Nick Langworthy (R-NY) used the hearing to make a broader transparency argument, noting that when health care costs rise, hospitals blame insurers, insurers blame hospitals, PBMs blame manufacturers, and manufacturers blame PBMs. He argued that the only way to determine who is responsible is for everyone to “flip their cards over” so policymakers can follow the money. Langworthy then asked Gremminger about the CHECK Act’s enforcement provisions and the importance of consistently enforcing transparency requirements. Gremminger agreed that existing requirements have not been consistently enforced and endorsed stronger enforcement and codification.
- Jake Auchincloss (D-MA) raised NADAC reporting and argued that Congress needs to understand actual drug acquisition costs if it wants meaningful transparency in drug pricing, pharmacist reimbursement, and patient copays. Gremminger said he is “a big fan of NADAC as a benchmark,” noting that other benchmarks are more easily gamed, while NADAC reflects what an unleveraged pharmacy can buy a drug for. Auchincloss also discussed 340B transparency and the administration’s proposed rebate model. Gremminger noted that employers often lack access to their own claims data and therefore have very little ability to understand how 340B affects them or whether they are losing access to rebates and discounts.
Taken together, the hearing reinforced a broader congressional theme that PBM reform is no longer being discussed only in the context of Medicare Part D or pharmacy reimbursement. It is now also being folded into larger conversations about employer fiduciary duties, commercial market transparency, vertical integration, MLR accounting, 340B, and health care consolidation.
- Upcoming Senate Armed Services TRICARE Hearing. The Senate Armed Services Subcommittee on Personnel announced that it will hold a hearing on July 15 at 2:30 PM to examine potential Express Scripts drug overcharges and conflicts of interest within the TRICARE pharmacy program. Other witnesses will include Rear Admiral David J. Smith, USN (Ret.), Deputy Director of the Defense Health Agency; Dr. Adam Kautzner, President of Express Scripts and Evernorth Care Management; and Greg Reybold, Vice President of Public Policy at American Pharmacy Cooperative, Inc.
The hearing will provide an important opportunity to elevate concerns regarding TRICARE pharmacy access, reimbursement, Express Scripts’ role in the program, and the impact of PBM practices on independent pharmacies and military beneficiaries. It also comes at a strategically important time, given the inclusion of Rx ACCESS-based TRICARE pharmacy audit language in both the House and Senate NDAA.
Federal Regulatory Activity
- FTC Reaches Proposed Settlement with UnitedHealth in Insulin PBM Case. On June 12, the Federal Trade Commission announced that it had reached a tentative settlement with UnitedHealth in the agency’s case against Optum Rx and its affiliated group purchasing organization, Emisar, over allegations that the nation’s largest PBMs inflated insulin costs. The FTC has paused its case against Optum Rx and Emisar while it considers a proposed consent agreement that, if approved, would resolve the claims against them in full. The details of the proposed Optum settlement have not yet been disclosed.
This development follows similar movement by the other two major PBMs. Cigna’s Express Scripts settled with the FTC earlier this year, and CVS Health reached a proposed settlement in March that has not yet been finalized. The FTC’s underlying lawsuit, filed in 2024, alleged that the “Big Three” PBMs, which collectively control roughly 80 percent of U.S. prescriptions, used anticompetitive practices to steer patients toward higher-list-price insulin products in order to capture larger manufacturer rebates. The PBMs have denied the allegations, but all three have now moved toward settlements with the agency.
FTC’s insulin case continues to put significant pressure on the largest PBMs and reinforces broader concerns about rebate-driven formulary design, conflicts of interest, and PBM practices that can increase costs for patients and distort the pharmacy marketplace. While the Optum settlement terms are not yet public, the earlier Express Scripts agreement required the PBM to delink its compensation from savings negotiated with manufacturers and stop favoring high-list-price drugs, suggesting the FTC is focused on structural changes to PBM incentives rather than simply monetary penalties.
- CMS Request for Information on PBM Compensation and Data Collection. On June 18, the Centers for Medicare & Medicaid Services released a request for information on PBM compensation and data collection, soliciting public comments on technical issues required to implement PBM reforms passed earlier this year. Public comments are due by 5:00 PM on July 20. The RFI will help shape how CMS implements the enacted PBM reforms and how the agency collects data regarding PBM compensation arrangements.
Other Policy Activity
- House Members Urge EBSA to Enforce CAA PBM Reforms. On June 1, Reps. Rick Allen (R-GA), Mariannette Miller-Meeks (R-IA), Nicole Malliotakis (R-NY), Nanette Barragán (D-CA), Lucy McBath (D-GA), and Bradley Schneider (D-IL) sent a letter to Daniel Aronowitz, Assistant Secretary of the Employee Benefits Security Administration at the Department of Labor, urging EBSA to fully enforce the PBM reforms included in the Consolidated Appropriations Act, 2026.
The Members emphasized that the CAA represented years of bipartisan work to increase PBM accountability and transparency and that meaningful implementation will require active oversight and guidance from DOL and EBSA. They specifically urged EBSA to use its authority to give full effect to the rebate pass-through requirement and the bona fide service fee standard.
The letter signals continued congressional oversight interest following enactment of the CAA PBM reforms.
Legislative Outlook
June reinforced a familiar dynamic, with PBM reform continuing to generate strong bipartisan interest, but the legislative calendar remained the central obstacle. The House Energy and Commerce hearing, the committee advancement of the Lower Costs, More Transparency Act, the introduction of the CHECK Act, and the inclusion of TRICARE pharmacy benefit language in both NDAA vehicles all show that lawmakers remain willing to advance PBM and health care transparency measures, particularly in the commercial market and in federal programs such as TRICARE.
That said, there is very little time left this year for major standalone health care legislation. With only a limited number of legislative weeks remaining before the August recess and the midterm election stretch, Congress is focused on a crowded list of must-pass items, including the NDAA, FISA-related issues, and appropriations before government funding expires on September 30. Even where there is bipartisan support for PBM reform, the practical challenge is finding a viable vehicle and enough floor time to move legislation.
The broader political environment has also become more difficult. Recent actions by the Trump Administration have strained relations with Democrats to the point of dysfunction and, in some cases, created frustration among Republicans as well. This has made it harder for House and Senate leadership to move even bipartisan legislation, particularly where the other party may be reluctant to give the majority a legislative win heading into the midterm elections. After the August recess, this dynamic is likely to intensify, making it increasingly difficult to advance any meaningful health care package, even one with bipartisan support.
As a result, the most realistic near-term opportunities for PBM-related progress are likely to come through implementation, oversight, and must-pass vehicles where pharmacy-related language is already in play. The FY2027 NDAA is the clearest example, as both the House and Senate bills now include Rx ACCESS-based TRICARE pharmacy audit language.
That provision is in a stronger position than most other PBM measures because it has been included in both chambers’ NDAA texts and is tied directly to military beneficiary access and DoD contractor accountability. The upcoming Senate Armed Services Committee hearing on the TRICARE pharmacy program should further reinforce the case for preserving the language by keeping congressional attention focused on access, network adequacy, and oversight of the TRICARE pharmacy benefit. That said, the provision is not yet law and could still change during floor consideration, conference, or final negotiations. Preserving the language in the final NDAA remains a top priority.
At the same time, targeted PBM legislation remains valuable, even if immediate enactment is unlikely. Bills such as the CHECK Act and the Lower Costs, More Transparency Act help sustain political pressure, define future policy options, and keep member offices engaged on specific aspects of PBM reform, including commercial market transparency, spread pricing disclosure, employer access to data, and middleman accountability.
Budget Reconciliation Outlook
The outlook for a third budget reconciliation package has deteriorated significantly. Reconciliation 3.0 now appears effectively stalled, if not dead, due to political gridlock, limited floor time, and disagreement among congressional Republicans over the scope and content of any additional package. Key Senate Republican appropriators, including Sen. Mitch McConnell and Sen. Susan Collins, have publicly pushed back on another major reconciliation effort. While President Trump and House Republicans have discussed additional defense spending, identifying sufficient offsets would be extremely difficult. Election-related provisions and broader intraparty disagreements have further complicated the path forward.
Timing is also a major obstacle. Congress has only a limited number of legislative weeks remaining before the midterm elections, and the schedule is already crowded with must-pass priorities, including the NDAA, FISA-related issues, and appropriations. Moving another budget resolution, drafting committee instructions, navigating House and Senate consideration, surviving Byrd Rule review, enduring a vote-a-rama, and resolving differences between the chambers would be extremely difficult under the current calendar.
Even if another reconciliation package were revived, it is unclear whether it would include health care provisions, much less PBM reform. Many PBM reforms are regulatory in nature and may not generate the direct federal budgetary effects required under the Senate’s Byrd Rule. Prior reconciliation discussions have already shown that PBM-related provisions can be vulnerable if viewed primarily as policy changes rather than budgetary measures.
Accordingly, reconciliation should no longer be viewed as a realistic path for PBM reform this year.
Prepared by Steven Irizarry, Managing Partner, and Casey Davison, Partner.