February 5, 2026

While it is nice to see steps towards transparency, there is still a big issue for lawmakers to contend with - Group Purchasing Organizations (GPOs). PBMs often create or control GPOs to help negotiate rebates and fees with drug manufacturers. While they increase negotiating leverage, many PBM critics argue that regulating PBMs without also regulating their affiliated GPOs simply shifts profits rather than increasing transparency.

HHS is explicitly linking homelessness, addiction recovery, and mental health treatment into a single coordinated funding strategy, signaling a shift away from siloed programs toward integrated, recovery-oriented care.

In 2024, nearly 53 million prior authorization requests were submitted for Medicare Advantage enrollees, averaging 1.7 per beneficiary, with about 8% fully or partially denied. While few denials were appealed, most appeals succeeded, highlighting that patients often face delays for services that are ultimately approved. The number of requests continues to rise as enrollment in the privatized Medicare program grows, and practices vary across insurers, with some submitting more requests per enrollee but denying fewer.

Express Scripts, one of the largest PBMs in the U.S., has agreed to significant reforms that enabled it to withdraw from a Federal Trade Commission lawsuit targeting major PBMs. The company plans to stop favoring high-list-price drugs on its standard formularies when lower-cost alternatives are available, delink its compensation from the savings it negotiates with drugmakers, increase transparency by disclosing data on drug spending and broker fees, and reshore its group purchasing organization from Switzerland back to the United States.

Efforts to modernize public health data reporting are essential for actionable surveillance and quicker responses to community health threats, but too often data systems remain siloed or qualitative rather than performance oriented. Strengthening CMS reporting incentives to focus on measurable quality, timeliness and completeness could help public health agencies allocate resources more effectively and improve real-time decision-making for disease prevention and control.