Monthly Legislative & Lobbying Activity Report for September 2026
Legislative Activity
Congress returned from the August recess for only a short September work period before both chambers left Washington for the midterm election campaign. Even within that limited window, there was some pharmacy-related activity on Capitol Hill. In the Senate, lawmakers introduced a bipartisan proposal aimed at improving acquisition-cost data for certain pharmacies participating in Medicaid, an issue that could have important implications for how pharmacy reimbursement is evaluated and set.
On the House side, lawmakers also continued examining prescription drug affordability, including a hearing focused on the cost of oral chemotherapy drugs and the financial burden those treatments can place on patients. Together, these developments reflected continued congressional interest in pharmacy reimbursement and patient access issues, even as the legislative calendar narrowed considerably ahead of the election.
Legislation
- Ensuring Accurate Payments to Specialty Pharmacies Act. Bill Cassidy (R-LA) and Mark Warner (D-VA) reintroduced this bipartisan proposal on September 29. It would establish acquisition-cost surveys for applicable non-retail pharmacies, including specialty and mail-order pharmacies, under Medicaid. The circulated text requires survey responses, public reporting, and enforcement through civil monetary penalties. Importantly for community pharmacies, it would prohibit states from using the non-retail pricing data to develop retail community pharmacy reimbursement rates.
Hearings
- House Oversight Subcommittee on Health Care and Financial Services hearing on the cost of oral chemotherapy drugs. On September 15, the House Oversight Subcommittee on Health Care and Financial Services held a hearing titled “Unequal Treatment: Addressing the Drivers of Unaffordability for Oral Chemotherapy.” Chairman Glenn Grothman (R-WI) highlighted differences in medical-benefit and pharmacy-benefit coverage, PBM-affiliated pharmacy markups, patient steering, and utilization-management requirements that can delay treatment. He also pointed to high initial out-of-pocket costs and prescription abandonment.
Grothman urged action on the bipartisan Cancer Drug Parity Act, H.R. 4101, to address disparities in coverage of oral and intravenous cancer treatments. The hearing reinforced congressional interest in PBM conflicts of interest and patient access.
Legislative Outlook
As of October 6, both the House and Senate are away for the pre-election recess and are not expected to return for regular legislative business until November 9. That leaves Congress with a very compressed lame-duck session of roughly five weeks before the 119th Congress comes to a close. During that period, lawmakers will have to deal with a number of major year-end priorities and other unfinished business, which means floor time will be extremely limited and leadership will be focused first on the legislation that simply has to get done. In that environment, moving standalone legislation will be very difficult, even when a bill has strong bipartisan support. That includes many PBM reform measures.
The more realistic path is to attach a targeted pharmacy provision, or potentially an entire pharmacy-focused bill, to a larger legislative package that is already moving. Even then, the window will be narrow. A provision would need the support of the relevant committee leaders, buy-in from congressional leadership, and a legislative vehicle that is viewed as appropriate for the policy. Any remaining cost, jurisdictional, or substantive concerns would also have to be resolved quickly, and the provision would need to survive the final negotiations between the House and Senate. Bipartisan support will be important and can help position a proposal for inclusion, but in a short lame-duck session it will not, by itself, guarantee that the provision makes it into a final package.
With that in mind, there are several year-end priorities that could provide an opening:
- Government funding. The current continuing resolution funds federal agencies through December 11. Congress will need to pass full-year appropriations or another extension to prevent a government shutdown. A broader funding agreement could provide an opportunity to include targeted PBM provisions. However, if lawmakers settle on a largely clean funding extension, there may be little room for additional health policy.
- National Defense Authorization Act. The annual defense authorization bill remains a major year-end priority and offers the clearest path for a TRICARE pharmacy audit request. The House passed its version on July 22, and both chambers’ proposals include pharmacy audit language.
- Health extenders. Funding for community health centers, the National Health Service Corps, and Family-to-Family Health Information Centers expires December 31. Congress will need to address those deadlines, potentially creating an opening for a year-end health package that includes targeted PBM reforms. The key question is whether lawmakers pursue a broader agreement or simply extend the expiring programs. A short extension would offer a much narrower opportunity.
- Other possible vehicles. The Farm Bill and other year-end negotiations may offer additional openings, depending on what Congress takes up and the scope of any agreement.
Prepared by Steven Irizarry, Managing Partner, and Casey Davison, Partner.