H.R. 1, or the Big Beautiful Bill, has brought substantial change to the managed care pharmacy landscape, particularly for managed care organizations (MCOs) with managed Medicaid lines of business.
One Big Beautiful Bill
On July 4, President Trump signed H.R. 1, often referred to as the One Big Beautiful Bill Act, into law. The massive budget reconciliation package marks a significant shift in federal health care policy. Along with a $5 trillion hike of the national debt limit, an extension of the 2017 Tax Cuts and Jobs Act, elimination of taxes on tipped and overtime income for some earners, and increased border security and defense spending, the law is offset by significant cuts to spending on federal programs including Medicaid, the Supplemental Nutrition Assistance Program, student loan support, and green energy initiatives.
Featured One Big Beautiful Bill Related Resources
On July 4, President Trump signed H.R. 1, often referred to as the One Big Beautiful Bill Act, into law.
On July 4, President Donald Trump signed H.R. 1, the One Big Beautiful Bill Act, into law.
On June 3, 2026, the Centers for Medicare and Medicaid Services (CMS) released educational materials for the Medicare GLP-1 Bridge program.
The Medicare GLP-1 Bridge program will start on July 1, 2026. Through this short-term demonstration, CMS will be expanding access to certain GLP-1 medications to eligible Medicare Part D beneficiaries who do not currently have access to these medications through the Part D benefit.
On June 1, 2026, the Centers for Medicare and Medicaid Services issued an interim final rule (IFR) with comment period to implement provisions in Public Law 119-21 (also known as “H.R. 1” or the "One Big Beautiful Bill Act").
Published One Big Beautiful Bill Related Resources
H.R. 1 will result in less preventive care and more preventable emergency room visits, increasing costs for everyone across the health care system and threatening hospitals with closure, which will further reduce access to critical care for American patients.
Academy of Managed Care Pharmacy (AMCP) issued a statement from CEO Susan A. Cantrell, MHL, RPh, CAE, following passage of the budget reconciliation bill that includes large-scale changes to Medicaid, the Affordable Care Act (ACA), Grad PLUS loans, and other programs.
Other Resources
- Modern Medicaid Alliance: Medicaid Provisions and Implementation of the One Big Beautiful Bill
- Modern Medicaid Alliance: Medicaid Dashboard
- Georgetown Center for Children and Families: Webinar: Budget Reconciliation (HR 1) Medicaid and Marketplace Provisions
- Congressional Budget Office: Analysis on the Passed H.R. 1
- KFF: Allocating CBO’s Estimates of Federal Medicaid Spending Reductions Across the States: Enacted Reconciliation Package
- Impact on Rural Health:
- KFF: How Might Federal Medicaid Cuts in the Enacted Reconciliation Package Affect Rural Areas
- Urban Institute: Rural Hospital Revenue Could Drop by $87 Billion over 10 Years Because of the Reconciliation Bill and Expiring Enhanced Tax Credits
- American Hospital Association: Rural Hospitals at Risk: Cuts to Medicaid Would Further Threaten Access
- SHVS: Medicaid Cuts and States: Tracking State-Specific Estimates of the Impacts of Proposed Changes
