Bipartisan bill could break up many kinds of health care companies

BenefitsPro

Reporter: Allison Bell

Sen. Elizabeth Warren, D-Mass., and Sen. Josh Hawley, R-Mo., have returned to the health policy wrestling ring with a new bill that could keep health insurers and many other types of health sector companies from owning their buyers or their vendors.

The new "Break Up Big Medicine Act" bill seeks to fight "vertical integration" in health care by prohibiting a company from:

◆ Owning a medical care provider and a pharmacy benefit manager at the same time.

◆ Owning a medical care provider and an insurer at the same time.

◆ Owning a prescription drug or medical device wholesaler and a medical care provider at the same time.

The bill does not appear to prohibit a health insurer from owning a PBM, according to a copy of the text posted by Warren's office.

An existing company that violates the requirements would have one year to comply.

The Federal Trade Commission, the U.S. Department of Health and Human Services, the U.S. Justice Department, state attorneys general and private parties could file suits against companies that violated the requirements.

If a company broke up as a result of the law, the FTC and Justice Department could keep the separated entities from taking actions that could create new concerns about vertical integration.

The senators' thinking: Warren and Hawley noted in the bill introduction announcement that three PBMs handle 80% of U.S. prescription drug claims, and that three prescription drug wholesalers handle 98% of U.S. drug distribution.

The big health care companies often own health insurers, PBMs, pharmacies and medical offices, and the combination of the companies' huge size and vertical integration helps those companies reduce the quality of care and increase the cost, Warren and Hawley said.

"Working Americans deserve better," Hawley said in a comment about the new bill. "This bipartisan legislation is a massive step towards making health care affordable for every American."

Warren said the new bill would end the "stranglehold that corporate giants have on our broken health care system.

"The only way to make health care more affordable is to break up these health care conglomerates," Warren said.

The backdrop: The new bill is a sequel to the Patients for Monopolies Act bill, a bill Warren and Hawley introduced in 2024, as the previous congressional term was ending.

The previous bill focused on requiring insurers and pharmacies to separate from PBMs.

One difference between the previous bill, which failed to advance out of the Senate Judiciary Committee, and the new bill is that the new bill arrives on the heels of President Donald Trump signing the Consolidated Appropriations Act of 2026 into law... CONTINUE READING