Monthly Legislative & Lobbying Activity Report for March 2026
Legislative Activity
Additional PBM Legislation Introduced
In March, lawmakers continued to introduce targeted PBM reform legislation building on the momentum generated by enactment of the Consolidated Appropriations Act, 2026. Although no broad standalone PBM package emerged during the month, the new bills reflected continued bipartisan interest in addressing PBM conflicts of interest, compensation arrangements, and pharmacy access issues in discrete but meaningful ways.
- ERISA Referral Compensation Restrictions. H.R. 7895, the PBM Kickback Act (Introduced March 12, 2026). Introduced by Rep. Rick Allen (R-GA), the bill would amend Section 408 of ERISA to prohibit PBMs servicing covered health plans from providing direct or indirect compensation to third parties for referring plan business. The measure is aimed at reducing conflicts of interest and increasing transparency in PBM contracting within the employer-sponsored insurance market.
- TRICARE Pharmacy Access and PBM Oversight. S. 4106, the Rx ACCESS Act (Introduced March 17, 2026). Introduced by Sens. Tom Cotton (R-AR) and Tim Kaine (D-VA), the bill is the Senate companion to H.R. 6400 and would modernize TRICARE’s pharmacy benefit by restoring beneficiary access to non-generic maintenance medications through any approved pharmacy channel, including retail. The legislation would also impose new PBM transparency and reimbursement standards, require annual GAO audits of pharmacy reimbursement and PBM fees, and direct DoD to submit an implementation plan to Congress.
Hearings
- Senate HELP Committee Member Day Hearing (March 19, 2026). On March 19, the Senate Health, Education, Labor, and Pensions (HELP) Committee held its Member Day hearing, providing senators an opportunity to advocate for legislation within the committee’s jurisdiction. The hearing did not feature direct discussion of the main PBM reform bills currently under consideration. However, it did include related benefit-design legislation, most notably the Safe Step Act (S. 2903), which addresses step-therapy exceptions and reflects continued congressional interest in utilization management practices that can affect patient access to care.
Other Lawmaker Activity
- House Oversight and Government Reform Committee Continues PBM Pressure. March also saw continued high-level congressional oversight of PBMs from key House Republicans. Chairmen James Comer (R-KY) and Robert Aderholt (R-AL) sent a letter to CMS Administrator Dr. Mehmet Oz urging CMS to use its existing authority to implement and reinforce the bipartisan PBM reforms enacted in the FY26 appropriations law. In the letter, the chairmen argued that CMS should take steps to ensure patients can access appropriate care without unnecessary barriers imposed by PBMs and should protect community pharmacies from harmful reimbursement and utilization-management practices.
The letter is notable because it underscores that congressional oversight of PBMs is not ending with enactment of the FY26 reforms. Rather, it reflects an effort by senior lawmakers to press CMS to use its administrative authority to complement the new statutory reforms and maintain pressure on PBMs
Federal Regulatory Activity
- Federal Trade Commission Investigation into PBMs. In March, the Federal Trade Commission reportedly reached a proposed settlement with CVS Caremark over allegations that the company helped inflate insulin prices and impeded access to lower-cost alternatives. This matter is part of the FTC’s broader multi-year investigation into PBM business practices, which began with the agency’s 2022 inquiry, continued through its July 2024 interim report, and culminated in the FTC’s September 2024 administrative complaint against CVS Caremark, Express Scripts, and OptumRx. That complaint alleged that the major PBMs used rebate-driven formulary practices to favor high-list-price insulin products over lower-cost alternatives.
Although the final terms of the CVS settlement have not yet been made public, reporting indicates that it is modeled on the FTC’s earlier February 2026 settlement with Express Scripts. That earlier settlement required significant structural changes, including enhanced transparency, constraints on rebate-driven pricing practices, and a shift toward more fee-based compensation and net-cost pricing. If the CVS settlement follows a similar structure, it would represent another meaningful step in the FTC’s effort to use the insulin cases to drive broader reform of PBM pricing and rebate practices.
Legislative Outlook
March reinforced that the policy momentum behind PBM reform remains real, but that the pathway for additional legislation this year remains challenging. On the one hand, lawmakers continue to introduce targeted PBM bills, key committee leaders are pressing CMS to build on the newly enacted reforms, and federal regulators — particularly the FTC — remain actively engaged in investigating and reshaping PBM practices.
On the other hand, conversations with congressional offices continue to reflect growing skepticism that major additional PBM legislation can move this year absent an obvious vehicle, particularly given election-year pressures, narrow margins, and a compressed legislative calendar.
Prepared by Steven Irizarry, Managing Partner, and Casey Davison, Partner.