This week, Congress did something that doesn’t happen often enough in Washington, DC – it proved the political pundits wrong. It passed a bill that included a host of health policy reforms championed by Republicans, Democrats, and Independents for the last 8 years. Importantly, these reforms reflect the policies ERIC has long fought for, including lower costs, increased transparency, and greater accountability.
Specifically, the inclusion of pharmacy benefit manager (PBM) reform in the final Consolidated Appropriations Act of 2026 (CAA) represents a major step forward for meaningful health care reform. The PBM provisions included in the final legislation help shine a light on PBM business practices, promote transparency, and ensure that negotiated savings benefit plan sponsors and patients – not middlemen.
For years, ERIC has carried the proverbial PBM policy football down the field. Some years, we gained yards in the policy debate. Other years, it was more like Lucy with the football in that old Charlie Brown cartoon. ERIC would get the ball down the field and be ready to kick it through the goal post for the win, only to have it yanked away at the last second.
Not this year. This year, policy to reform the PBM industry and instill greater accountability and transparency made it across the goal line, and the victory couldn’t be sweeter! This achievement is the result of broad collaboration among diverse stakeholders who never gave up and worked together to finish the job. Large employers, small employers, community pharmacists, patient and disease advocacy groups, transparent PBM allies, and stakeholders across America all played a significant role in elevating the need for PBM reform.
ERIC was there every step of the way. Sometimes ERIC led these coalitions, sometimes we provided the employer perspective, and other times we were the voice setting the record straight, so special interests with deep pockets didn’t drown out voices of reason and common sense. Our efforts, alongside these stakeholders, helped ensure that Congress remained focused on advancing solutions that will deliver real relief for working families.
We also applaud the bipartisan leadership in Congress that recognized the importance of addressing prescription drug costs and included PBM reform language in the final package. Remaining determined and continually listening to employers, workers, and patients alike, Congress demonstrated a clear commitment to accountability and affordability. We are grateful for their efforts and the work they’ve done alongside the Trump administration to deliver a victory for all stakeholders who will see it where it counts – in their pocketbooks.
The inclusion of PBM reform in the CAA is a positive milestone. Still, it was only one of several policy wins for ERIC member companies in the final bill. In addition, the bill includes a requirement for “honest billing” transparency in Medicare, requiring off-campus hospital outpatient departments to bill using unique National Provider Identifiers (NPIs). This reform will enable carriers to use NPI data to determine whether care took place at a hospital or not, and to ensure that billing reflects this – wiping out inappropriate facility fees, pushing back on upcoding, and curbing the disastrous health system consolidation trend.
This is an important down payment by Congress on the need to address anti-competitive hospital practices and the ill effects of provider consolidation. There is more to do on this front, and ERIC stands ready to help educate lawmakers about the need for enhanced hospital transparency, site neutral payment reforms, fairness in contracting, and a return to the original intent of the 340B program, among others.
The Consolidated Appropriations Act of 2026 shows what is possible when stakeholders work together toward common goals, and it moves us closer to a more transparent, accountable, and affordable health care system for employers, employees, and patients nationwide.
These victories are a cause for celebration.