Bipartisan bill could break up many kinds of health care companies

◆ 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.

The CAA 2026 spending package includes one employer PBM section that requires PBMs to pass all rebates or other discounts they negotiate for employer health plans through to the employer plans or the participants.

Another CAA 2026 section requires PBMs that serve employers to send the employers detailed reports about their prescription benefits. The employers will have to make summaries available to the employees.

Rep. Buddy Carter, R-Ga., and other lawmakers have been trying to get employer PBM bills through Congress for years, and enactment of the employer PBM provisions may give many other federal health benefits proposals that previously had appeared to be dead on arrival new life.

House Republicans: Another factor that could improve the prospects for bills like the new Warren-Hawley bill is some House Republicans' fury about health insurers and PBMs.

Rep. Greg Murphy, R-N.C. — a urologist who recently had surgery to treat a benign brain tumor — blasted the chief executive officer of CVS Health, the parent of Aetna and the Caremark PBM, as well as of the CVS drug stores, at a recent House committee hearing.

"There has been systematic denial and delay of care," Murphy said at the hearing. "I don't agree with Mark Cuban often, but we do agree that what needs to happen is that you need to be broken up."

Carter attack vertical integration of health insurers and PBMs at a press conference on Capitol Hill last week.

"The PBMs add no value to this system at all," Carter said. "When you say PBMs, you might as well say insurance companies. Because it's the same thing."

The insurers: Health insurers contend that they work hard to reconcile the competing interests of health care providers, patients, employers, government payers and other health care system players and tend to earn slim profit margins.

They point out that some of the big health insurers are nonprofit organizations or member-owned organizations, and that nonprofit, member-owned and employer-owned plans tend to end up facing all of the same problems that the for-profit insurers do, and that, in some cases, vertical integration may be the best available strategy to cope with privacy concerns, information technology needs, and efforts to improve the quality of health care products and services and reduce the cost.

From their perspective, the pressure is coming from Washington at a time when the underlying cost of health care is climbing and profits are down.

What it means: For employers, the introduction of the new Warren-Hawley bill is part of a stream of health benefits-related bills that could just dry up or could lead to big changes.