November 5, 2026

CVS Health plans are splitting into two publicly traded companies by the first half of 2028: one combining Aetna, Caremark, and its healthcare delivery businesses, and the other housing its 9,000 retail pharmacies. The decision reverses CVS’ longstanding vertical integration strategy and is intended to make both businesses more competitive and operationally focused amid increasing regulatory scrutiny and financial pressures on the healthcare industry.

The Department of Labor finalized a rule requiring PBMs to disclose detailed compensation information, including drugmaker rebates, pharmacy payments, and spread pricing, to self-funded employer clients beginning in July 2027. The rule aims to increase transparency, strengthen employers’ ability to audit and negotiate PBM contracts, and reduce prescription drug costs, with an estimated $22 billion in savings over 10 years. PBMs have opposed the rule, arguing that it creates redundant reporting requirements and unnecessary administrative burdens.

A federal judge struck down CMS’ “medical frailty” policy for Medicaid work requirements after more than two dozen states challenged the definition. The policy limited who could qualify for a medical exemption from the new work requirements. CMS could still appeal the ruling, which may affect how medical exemptions are determined as states prepare to implement the requirements.

Medicare Part D premiums are expected to increase by about 50% on average in 2027, although the amount will vary significantly depending on the plan. The increases affect stand-alone prescription drug plans, meaning some beneficiaries could see considerably higher monthly costs next year. KFF noted that beneficiaries may be able to avoid some of the increase by comparing available plans and switching to lower-cost coverage during Medicare open enrollment. The wide variation in premiums makes reviewing plan options particularly important for beneficiaries rather than automatically renewing their current coverage.

The election results could put ACA affordability and Medicaid funding back at the center of the healthcare debate. Even if major legislation faces political hurdles, increased congressional oversight and renewed efforts to restore enhanced ACA subsidies could have meaningful implications for payers and consumers heading into 2027.