For months, Washington has inched toward a healthcare reckoning without ever fully committing to it. Then, somewhat unexpectedly, a FY26 minibus landed, not as a grand overhaul or solve for the biggest policy issue, but as something increasingly rare in federal health policy: a clear assertion of control.

The clearest signal is to pharmacy benefit managers. After years of hearings, headlines and public frustration over opaque practices, Congress finally moved from concern to constraint. Buried in appropriations language are real guardrails: delinking PBM compensation from list prices, increasing transparency around rebates, and strengthening government oversight of contracts.

The message is subtle but present: Scrutiny is beginning to translate into oversight. Congress is holding its ground as PBM lobbyists pushed back (and pharmacy groups applauded).

Elsewhere, a handful of long-running policy debates finally found stronger footing.

• Telehealth flexibilities and hospital-at-home, pandemic-era policies, which have survived on a cycle of short-term extensions, are now in place through 2027 and 2030, respectively.
• One quiet but consequential win: The revival of the FDA’s Rare Pediatric Disease priority review voucher program, a targeted incentive with meaningful implications for rare disease development.
• In the bill’s text, legislators request a briefing from 340B program administrators to address how the proposed rebate model pilot program may “increase costs for patients or limit access to their prescriptions.”

From a broad perspective, the minibus doesn’t transform the healthcare system. But it stabilizes key parts of it, which is arguably just as important right now. In a term defined by volatility, Congress is signaling that at least some elements of health policy must hold steady.

– Stephen Tellone, Associate Director

The annual meeting of the World Economic Forum – better known by its location of Davos, Switzerland – serves as a catalyst to convene world leaders in the name of “forward-looking discussions” on the most-pressing global issues. This year’s meeting might be best remembered for Arctic geopolitics and a threat of economic war via tariffs.

Though talks have reduced the boil to a simmer, the moment served as a pressure test for trade deals with Europe and its resident drugmakers. During Davos’ apex on Wednesday, members of the European Parliament postponed a trade committee vote on a deal with the U.S. that would cap tariffs on EU pharmaceutical exports. Swiss drugmaker Novartis appeared unfazed, however, with CEO Vas Narasimhan telling CNBC he expects the drugmaker’s agreement with the White House and promised U.S. investment to mitigate tariff exposures.

President Donald Trump even reserved time for prescription drugs in an hourlong address, highlighting the “unfairness” of U.S. drug pricing compared to Europe. Trump praised the power of tariffs to persuade nations such as France to raise prescription drug prices, an assertion French officials called “fake news.”

Pfizer CEO Albert Bourla backed up France’s account though not in a positive light, saying that lowering prices in the EU has been a “cumbersome process” compared to the U.S. The executive zeroed in on a different pain point of U.S. health policy, lamenting how the leadership of HHS Secretary Robert F. Kennedy Jr. has slashed scientific funding and influenced vaccine discourse.

“I have very productive discussions when it comes to cancer cures, when it comes to the ‘most-favored nations’ deal, et cetera,” Bourla told The Wall Street Journal. “It’s a different world when you start discussing vaccines, there’s almost like a religion there.”

– Andrew Wishon, Senior Manager

Lawmakers turned up the heat on the health insurance industry this week, hauling the CEOs of UnitedHealth, CVS Health, Cigna, Elevance and Ascendiun to back-to-back hearings focused on affordability.

Members from both parties dug in on coverage denials, consolidation and executive compensation as premiums rise and consumers feel squeezed. Insurers responded that premiums are largely a “symptom” of underlying medical and drug costs. Republicans, in particular, have leaned into anti-insurer rhetoric as Trump has pivoted the affordability debate from pharma companies to payers.

This pressure, coupled with reforms in the minibus (see above!), lands after years of intensifying scrutiny of PBMs from federal agencies.

• The Federal Trade Commission has led a yearslong investigation into alleged PBM behaviors that increased specialty generics pricing and steered patients to owned pharmacies.
• In 2024, the FTC filed suit accusing the three largest PBMs and their affiliated group purchasing organizations of inflating insulin list prices through anticompetitive practices –a case in which one insurer is reportedly exploring a settlement.

Notably, payers are now openly warning that reforms could cut deep. Cigna has quantified the earnings impact of ending (or effectively delinking) traditional drug rebates, estimating a $500 million to $600 million reduction. Such figures affirm how policy shifts aimed at lowering pharmacy costs may materially reshape insurer and PBM business models.

– Megan Hickey, Senior Group Director

• Jan. 28 – annual Health Solutions Summit on “ways to curb rising Medicare spending and health care costs,” Committee for a Responsible Federal Budget

• “But beyond the many unanswered questions about the substance of the [MFN] deals is the flawed premise on which they are based… that the U.S. should rely on other nations to determine the value of medications taken by Americans, rather than determine that value for ourselves.” – Lisa Jarvis, Bloomberg
• “While the [FDA] emphasizes that it will still enforce appropriate standards as the flexibilities come into play, that’s going to be easier said than done. The Center for Biologics Evaluation and Research will have to walk a tightrope to speed things up this way without compromising safety and its own authority.” – Paul Knoepfler, STAT
• “Institutions once relied on for evidence-based advice now reliably serve political and anti-science agendas rather than public health. With this change, the government has decided that there is an acceptable amount of death and disease that is permissible, even though we have the tools and the science to prevent it.” – Anna Larson et al., Health Affairs Forefront

• Some pharmaceutical companies are rethinking the timing of EU launches as the U.S. works toward a most-favored nation pricing scheme. Financial Times: US drugmakers threaten to withhold products from Europe over prices.
• A new poll shows voters are broadly skeptical of HHS Secretary Kennedy’s vaccine overhaul, with many saying it has made them less confident in federal vaccine guidance. The Wall Street Journal: Voters Skeptical of RFK Jr.’s Vaccine Overhaul.
• As formulary exclusions grow for 2026, PBMs are prioritizing their own private-label biosimilars and lower priced products, underscoring the industry’s shift toward net-price competition. Drug Channels: The Big Three PBMs’ 2026 Formulary Exclusions: MFP, Private Label Biosimilars, and Direct-to-Patient Threats for PBMs.
• All but 17 companies avoided the White House’s first push for major price cuts last year, though drugmakers are now preparing to enter similar pacts amid political pressure. Endpoints: Large drugmakers without a US pricing pact are bracing to make one.
• The FDA lost 20% of its reviewers in 2025, prompting warnings that the agency will face reduced application quality and tougher approval pathways in 2026. Pink Sheet: US FDA’s 2025 Staffing Turmoil Will Create 2026 Application Review Challenges.
• Top drugmakers trimmed Washington lobbying funding in the final quarter of 2025, a modest pullback after a year of elevated policy pressure. Endpoints: Top drugmakers spent slightly less on Washington lobbying in 2025’s final quarter.
• Eli Lilly CEO David Ricks has become one of Trump’s favored pharma executives through flattery, strategic donations and leadership in the company’s pricing deal for GLP-1 medicines. Politico: This pharmaceutical executive has Trump’s ear.
• The Supreme Court will hear a high-stakes patent case between Amarin and Hikma Pharmaceuticals that could reshape the legality of “skinny label” generic drug marketing. STAT: Supreme Court agrees to review ‘skinny labeling’ and generic drug access.
• One year after Trump ordered the exit, the U.S. has formally completed its withdrawal from the World Health Organization. AP News: US completes withdrawal from World Health Organization.