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PBM reforms might unlock new arrangements for employers

February 5, 2026
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Washington Correspondent, D.C. Diagnosis Writer

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employers

Unlocking 'creative arrangements'

After several years of talking about it, Congress passed PBM reforms on Tuesday. Now we wait to see what comes of it.

Elizabeth Mitchell, CEO of the Purchaser Business Group on Health, said the new reporting requirements could "unlock creative arrangements," like large self-insured employers buying drugs directly from drugmakers, and changing how employers contract with PBMs.

That's also the point of TrumpRx, though possibly on a smaller scale focused on individuals. Read more.



ftc

Moving a GPO within easier reach

Ed Silverman has more PBM news: The FTC settled a lawsuit against Express Scripts alleging the PBM inflated the price of insulin and impeded access to the diabetes treatment.

One of the settlement terms requires Express Scripts to move its group purchasing organization, Ascent, from Switzerland to the U.S. Although the new PBM law applies to PBM-affiliated entities and specifically calls out GPOs, there is some concern that PBMs might try to insulate the GPOs from some of the law's requirements, such as mandatory commercial market rebate passthroughs. GPOs are separate corporate entities from the PBMs, and they're located in foreign countries where U.S. laws don't apply. 

Read more about the settlement entails.


fraud

Inside HHS' anti-fraud efforts

In a video posted to social media last month, CMS Administrator Mehmet Oz drives through a Los Angeles neighborhood, pointing out health care facilities he accuses of committing fraudulent activity. In another post, he poses, arms crossed with a serious expression on his face, in front of a Minnesota courthouse as part of a "fact-finding" mission into fraud in the state. These are part of a recent HHS-wide effort to uncover fraud in federal health care systems.

Chelsea Cirruzzo reports that while federal officials across administrations have focused on rooting out fraud in health care programs, these efforts have flipped a traditional script: Rather than focus on individual providers, the Trump administration has put entire states in its crosshairs, notably those with Democratic leadership.

And that approach has left Medicare and Medicaid experts, as well as legal experts, suspicious that the mission is more about politics than fraud even as HHS General Counsel Mike Stuart tells STAT that red states are also in its crosshairs.

Read more.


fda

Vouching for vouchers

At an employee town hall, FDA leaders tried to convince staff that a controversial new program to fast-track certain drugs isn't politically motivated and that, furthermore, the program was really staff's idea, according to Lizzy Lawrence.

"If it were up to me, we'd remove the name 'Commissioner' from the priority voucher program, because this is really an idea that came from you," Makary said.

Lizzy listened to a recording of the private meeting. Read more about what the commissioner told employees and what the employees asked the commissioner.


drug reviews

Tripping up shrooms fast-track review

Lizzy, Elaine Chen, and Damian Garde tell us of an episode involving a psilocybin treatment that underscores the ways political pressure has shaped the priority voucher program.

In a previously unreported account, they write that Trump administration officials vetoed the FDA's plan to fast-track the review of a psychedelic treatment for severe depression.

The incident highlights possible internal discord between administration leadership and MAHA, which advocates for psychedelic medicines.

Read more about how it happened.


gender-affirming care

Plastic surgeons take position on gender-affirming surgeries

The American Society of Plastic Surgeons recommends that gender-affirming surgeries be delayed until a patient is at least 19 years old, Daniel Payne and Theresa Gaffney report.

That stance is more conservative than other major U.S. medical groups, and it drew quick praise from Trump administration officials who have taken a hard line against gender-affirming care, including opening FBI and Justice Department inquiries into hospitals and doctors, as well as conditioning the payment of huge sums of federal money to hospitals on prohibiting the care.

However, the plastic surgeons organization decried pursuing criminal or punitive measures against doctors providing gender-affirming care.

Read more about how the medical society arrived at its position.


immigration

The health consequences of ICE's crackdown

Daniel wrote a poignant reminder of what ICE's crackdown means for the care of immigrants.

His article opens with a woman in labor who didn't seek medical attention until it was too late, resulting in a stillbirth.

Such situations have become increasingly common, doctors told Daniel. They've noticed an increase of immigrant patients avoiding care, including pregnant mothers and parents with sick children, since the Trump administration launched its aggressive immigration enforcement actions.

Read more.


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What we're reading

  • AI doctors are coming. Should FDA make sure they're safe?, STAT
  • From Croatia to MAHA: How an unapproved drug became the next hot peptide, Undark
  • Opinion: Measles in an ICE facility is a public health failure, STAT
  • MAHA's money man has built a political machine. Will it matter for midterms?, CNN

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