Health Policy Report – February 11, 2026

Dr. Schuler of Compass Oncology Meets with Oregon Governor Tina Kotek

Dr. John Schuler, radiation oncologist at Compass Oncology, recently met with Oregon Governor Tina Kotek to share more about Compass Oncology’s mission, care model, and impact across the state. This provided an opportunity to highlight Compass Oncology’s long-standing commitment to delivering high-quality, patient-centered cancer care in community-based settings in Oregon.

The Network and Compass Oncology look forward to working alongside Governor Kotek and other state lawmakers to expand patients’ access to community-based care.

President Trump Signs Spending Package that Includes PBM, Site Neutral Provisions

Congress recently passed the Consolidated Appropriations Act of 2026, a minibus funding package that includes appropriations for the Department of Health and Human Services (HHS). The bills include a variety of key health provisions that bolster site neutral policies, enhance transparency among pharmacy benefit managers (PBMs), and extend telehealth flexibilities.

The package includes a two-year extension of Medicare telehealth flexibilities. Beginning on January 1, 2028, each off-campus outpatient department must obtain and bill under its own National Provider Identifier (NPI), separate from the hospital’s primary NPI. This policy marks a notable shift, tightening transparency among hospitals and shaping future debates around site neutral payment reform.

The bill also includes several provisions seeking to rein in PBM practices, such as banning spread pricing and bona fide service fees. It also requires PBMs to complete transparency reports and strengthens contract standards to ensure that pharmacies are protected from unfair reimbursement practices.

The legislation creates new Medicare coverage, beginning January 1, 2029, for Multi Cancer Early Detection (MCED) blood tests that can screen for multiple types of cancer at once. Additionally, the bill revises Medicare’s clinical laboratory payment timeline by extending the phase-in period for laboratory test payment changes by an additional year, moving the end date from 2028 to 2029. This gives clinical laboratories more time to adapt to the updated payment system and avoids abrupt reimbursement shifts.

To read more, CLICK HERE.

Senators Hawley and Warren Introduce Break Up Big Medicine Act

On February 10, Senators Josh Hawley (R-MO) and Elizabeth Warren (D-MA) introduced the Break Up Big Medicine Act in the Senate. The legislation proposes limitations on management services organizations (MSOs) that they claim own or control various parts of the healthcare supply chain, from the physician’s office to the pharmacy.

The legislation would prohibit a parent company from owning a medical provider or management services organization and a PBM or an insurer and prohibit a parent company of a prescription drug or medical device wholesaler from owning a medical provider or management services organization. It would also create financial penalties and enable the Federal Trade Commission, Health and Human Services Department, and Justice Department to bring lawsuits against those who don’t comply.

This legislation is unlikely to pass in the current Congress. While Senator Warren has expressed interest in taking a closer look at vertical integration in the health system, the proposal remains unlikely to advance. We will continue to monitor developments on this and any similar legislation.

To read the bill text, CLICK HERE.

To read a press release on the bill, CLICK HERE.

Medicare Drug Price Negotiation Enters Third Cycle

On January 27, the Centers for Medicare & Medicaid Services (CMS) announced fifteen more medications to undergo Medicare drug price negotiations. The list includes Johnson and Johnson’s prostate cancer drug Erleada, Kisqali, a CDK4/6 inhibitor medication manufactured by Novartis to treat specific forms of breast cancer, Eisai’s Lenvima, an oral receptor tyrosine kinase used to treat specific forms of thyroid, liver and kidney cancer, and Verzenio, an oral CDK4/6 inhibitor treatment for breast cancer.

Senate Finance ranking Democrat Ron Wyden (D-OR) criticized the Trump administration for excluding Keytruda and Opdivo – two top-selling cancer drugs – from this list. Drug companies with a selected drug for the third cycle of negotiations will have until Feb. 28 to decide if they will participate in negotiations.

The agency also announced that it will renegotiate the maximum fair price of Boehringer Ingelheim’s Tradjenta, which previously went through the negotiation process.

The announcement comes as the Medicare drug price negotiation program continues to be challenged in court. As of January 23, six companies have filed a petition or plan to file a petition asking the Supreme Court to review their legal cases challenging the Medicare drug price negotiation program.

To read the announcement, CLICK HERE.

To read more, CLICK HERE.

Senator Bill Cassidy, MD (R-LA) Continues Investigation Into 340B Drug Pricing Program

Senator Bill Cassidy, MD (R-LA) – Chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee and a long-standing critic of the 340B Drug Pricing Program – announced that he is seeking information from 340B prime vendor Apexus. The inquiry comes after reports that Apexus is generating hundreds of millions in profits from 340B and expanding its business to increase profitability. 

“As I indicated in my report on the 340B Program last spring, a serious lack of transparency in the 340B Program prevents 340B discounts from translating to better access or lower costs for patients,” wrote Dr. Cassidy in a letter to Apexus President Christopher Hatwig. “In light of Apexus’s role as the current 340B prime vendor, and given questions raised into its business practices, I am requesting information and data to better understand how Apexus generates its revenue and designs its commercial offerings related to the 340B Program.”

In the letter, Dr. Cassidy inquired about whether employees’ compensation is tied to the growth of the 340B program, whether it shares administrative fees with other entities, and whether employees work with covered entities to increase 340B drug utilization.

To read the letter, CLICK HERE.

Dr. Oz Meets with Senate GOP, Senate Democrats Release Drug Pricing Plan

Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, M.D., Medicare Director Chris Klomp, and special assistant to the president for domestic policy Theo Merkel recently met with Republican senators to push for legislation to lower U.S. drug prices. Specifically, they discussed codifying the Trump administration’s most favored nation (MFN) drug price plan into law.

These officials urged federal lawmakers to require drugmakers to offer Medicaid the lowest prices available and push for future drugs to be sold at low prices in the U.S. but offered no further detail.  During the meeting, some GOP senators expressed concern about government price controls interfering in the free market. The meeting was part of a larger push by the White House to urge Congress to emphasize transparency and efficiency in the healthcare industry.

Meanwhile, Senate Democrats, led by Senator Ron Wyden (D-OR), ranking member of the Senate Finance Committee, released their own drug pricing plan in a Dear Colleague memo. The group, including Sens. Catherine Cortez Masto (D-NV), Peter Welch (D-VT), and Ruben Gallego (D-AZ), outlined priorities such as incorporating international pricing into the Medicare drug price negotiation program, lowering patient cost-sharing on drugs, and creating new incentives for drug development through the tax code.

Wyden said that the Senate Finance Committee minority staff would be working on developing these policies into legislative text in the coming months.

To learn more, CLICK HERE.

To read the letter from the Senators, CLICK HERE.

Department of Labor Proposes PBM Transparency Rule

The Department of Labor recently proposed a new rule, titled “Improving Transparency into Pharmacy Benefit Manager Fee Disclosure,” aiming to put more pressure on pharmacy benefit managers (PBMs) to disclose their financial dealings with drugmakers, pharmacies, and other health system players.

If enacted, this rule would force drug middlemen like CVS Caremark, Express Scripts, and Optum Rx to make semiannual disclosures to employers of what they earn for negotiating drug prices on behalf of health plans. Self-insured group health plans would also get to audit PBMs once a year, and the PBMs must provide an explanation if they make 5 percent or more of what they originally estimated.

However, the proposed rule does not limit “spread pricing,” which occurs when a PBM charges a health plan more than it pays a pharmacy for a drug.

To learn more, CLICK HERE.

To read the proposed rule, CLICK HERE.