Letters, Statements & Analysis

On Jan. 22, the House Energy & Commerce Health Subcommittee and House Ways & Means Committee held hearings with the Chief Executives of five major health insurers. With a focus on affordability, Members and witnesses each shared a series of questions, proposals, and commitments regarding the increasing costs of care in the United States. And while health policy proposals continue to face partisan gridlock in Congress, legislators on both sides of the aisle agreed that health insurance premiums have risen exponentially, while increasing rates of prior authorization denials hamper patient access to care.

AMCP’s Policy Outlook 2026 provides a forward-looking analysis of the political, legislative, and regulatory developments poised to shape managed care pharmacy in the year ahead, from the 2026 midterm elections and government funding deadlines to major policy debates around PBM reform, Medicare drug price negotiation, GLP-1 coverage, direct-to-consumer drug models, and the 340B program. Designed to help managed care professionals anticipate change and plan strategically, the report breaks down what to expect from Congress, federal agencies, and the administration—and what it all means for patient access, costs, and pharmacy operations. Download the full Policy Outlook 2026 to explore the key issues, timelines, and implications that will define the policy environment in the coming year.

On Dec. 19, the Trump administration closed out a year of international pharmaceutical reference pricing announcements with the publication of CMS’s proposed Global Benchmark for Efficient Drug Pricing (GLOBE) and Guarding U.S. Medicare Against Rising Drug Costs (GUARD) models, as well as the release of nine additional Most-Favored-Nation (MFN) pricing arrangements with major pharmaceutical manufacturers. The announcements align with the Trump administration’s goal of lowering the prices that American patients pay for prescription drugs to the prices paid in similarly developed countries, as well as May 12 Executive Order on delivering MFN prices to patients.

On Dec. 4, Senators Mike Crapo (R-ID) and Ron Wyden (D-OR), Chair and Ranking Member of the Senate Committee on Finance, introduced the PBM Price Transparency and Accountability Act (S. 3345). The bill’s introduction signifies Congress’ appetite towards passing pharmacy benefit manager (PBM) reform, with many of the bill’s provisions included in earlier reform proposals adopted at the state level. This includes bans on the use of spread pricing arrangements, delinking PBM compensation from the price of a drug, and increased transparency into PBM contracts and business practices.

On Friday, November 21, the Centers for Medicare and Medicaid Services (CMS) released CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payments Final Rule, updating Medicare rates and announcing policy changes. The rule includes payment increases for hospitals and ASCs meeting quality reporting requirements and outlines significant reforms related to drug payment and procedural lists. There is a 30-day notice for comments on IRA negotiation factors for 2028 (comment period will begin once forms are published).

As mostly non-pediatric organizations representing public health, older adults, patients, family caregivers, consumers and healthcare workers, we support everyone having access to every vaccine they need, regardless of their age. In the United States alone, routine childhood vaccinations for children born between 1994 and 2023 are projected to prevent about 1.13 million deaths, and hundreds of millions of illnesses and hospitalizations. Put simply, childhood vaccines make healthy adults.

On Tuesday, November 25, the Centers for Medicare and Medicaid Services (CMS) released the Maximum Fair Prices (MFPs) for 15 products selected for negotiation under the Medicare Drug Price Negotiation Program (MDPNP). The MFPs for these products will take effect in Medicare Part D starting in 2027, bringing the total number of products with negotiated prices to 25.

On Nov. 9, the Senate voted to end the longest federal government shutdown in history, with Majority Leader John Thune (R-SD) promising to hold a floor vote on a bill to extend the expiring Affordable Care Act (ACA) enhanced premium tax credits (PTCs) in mid-December. On Nov. 19, the Senate Committee on Finance held a hearing to discuss solutions to lower Americans’ health care costs, in which witnesses and Senators primarily focused on the role of the ACA.

AMCP commends ACIP’s commitment to regularly reviewing the scientific evidence underlying national immunization recommendations. We recognize the importance of maintaining guidance that is both scientifically rigorous and operationally feasible across diverse care settings. In that spirit, we offer the following comments on the Committee’s ongoing consideration of vaccine safety and the hepatitis B vaccine birth-dose recommendation.

On Sunday, November 9, Senate Majority Leader Thune announced that he had reached an agreement with a group of 8 Democratic senators and the White House on a deal to end the longest shutdown in U.S. history. On Monday, November 10, the Senate approved the government funding bill by a vote of 60-40, which sends the legislative package back to the House of Representatives.

President Donald Trump announced a series of agreements with Eli Lilly and Company and Novo Nordisk to offer Most-Favored-Nation (MFN) prices on two GLP-1 therapies, semaglutide (brand names Ozempic and Wegovy) and tirzepatide (brand names Mounjaro and Zepbound). This marks the fourth and fifth publicly announced agreements between the Trump administration and pharmaceutical manufacturers, joining earlier announcements with Pfizer, AstraZeneca, and EMD Serono. The manufacturers also agreed to cap prices for insulin products and other commonly prescribed diabetes medications.

On Saturday, October 11, Governor Gavin Newsom signed SB 41, a bill that limits certain business practices employed by pharmacy benefit managers (PBMs) in California. This bill follows previous attempts by the governor to regulate PBMs, including changes implemented in the budget that require PBMs to obtain a license, submit detailed operational and financial statements annually to the Department of Managed Health Care, and act in the best interests of health plans and covered individuals.