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On June 25, 2026, the House Energy and Commerce Health Subcommittee held a markup to consider 15 bills to increase price transparency across the health care sector, including hospitals and insurers, to address concerns about prior authorization and other practices by Medicare Advantage plans, and to deal with the public health threat posed by illicit drugs. This memo covers the legislation related to price transparency and Medicare Advantage. All bills were advanced to the full committee on voice votes. Full Committee Ranking Member Frank Pallone (D-NJ-6) offered general support for the price transparency legislation but raised concerns about the Prices on the Wall Act, arguing that it could cause more confusion than it would help. Several amendments were offered during the markup but were ultimately withdrawn following a commitment from both Full Committee Chairman Bret Guthrie (R-KY-2) and Health Subcommittee Chair Morgan Griffith (R-VA-9) to work on the bill before it goes to full committee.
OPENING STATEMENTS
- Full Committee Chairman Bret Guthrie (R-KY-2)
- Full Committee Ranking Member Frank Pallone (D-NJ-6)
- Health Subcommittee Chairman Morgan Griffith (R-VA-9)
- Health Subcommittee Ranking Member Diana DeGette (D-CO-1)
PRICE TRANSPARENCY AND MEDICARE ADVANTAGE LEGISLATION MARKED UP
H.R. 9393, the Lower Costs, More Transparency Act of 2026 (Reps. Guthrie (R-KY-2) and Pallone (DNJ-6)), to require hospitals, surgical centers, labs, and imaging providers to post prices and require health plans to disclose negotiated rates, cost-sharing estimates, and pharmacy benefit manager (PBM) spread pricing.
- Full Committee Chair Guthrie and Ranking Member Pallone spoke in favor of this bill, highlighting the amount of bipartisan work that went into getting to this point.
- Rep. John James (R-MI-10) stated he would support this bill but believes it does not go far enough in terms of making the prices easy to understand. He shared that he would be putting up his bill, H.R. 5582, the Patients Deserve Price Tags, as an amendment to strengthen the underlying bill.
- Rep. Greg Landsman (R-OH-1) offered an amendment to tack on language to ensure that the data shared is transparent, accurate, and understandable. This amendment was withdrawn after Rep. Landsman acknowledged it did not have the support.
- Rep. Buddy Carter (R-GA-1) offered an amendment to include language from the DOC Access Act, which would promote transparency of the vision and dental benefit industry. He argued that vision benefit managers (VBMs) cause harm to patients as they do not have a choice in their eye doctor or treatment. This amendment was withdrawn.
- Health Subcommittee Ranking Member Diana DeGette (D-CO-1) offered an amendment to include language requiring certain entities to share their ownership structures. This amendment was withdrawn following assurances from Health Subcommittee Chairman Griffith that they could talk about implementing changes.
- This bill was forwarded to the full committee following a voice vote.
H.R. 9397, the Premium Transparency Act (Reps. August Pfluger (R-TX-11) and Nathanial Moran (R-TX-1)), to ensure health insurer accountability through publishing of overhead costs and claim payments.
- Health Subcommittee Ranking Member DeGette highlighted that this language was already put into law within the ACA, but would still support the legislation.
- This bill was forwarded to the full committee following a voice vote.
H.R. 9396, the Prior Authorization Accountability Act (Rep. Craig Goldman (R-TX-12)), to require insurers to display which services were subject to prior authorization, the percentage of requests approved or denied, and the average amount of time between the request submission and determination.
- Health Subcommittee Chair Griffith, Health Subcommittee Ranking Member DeGette, and Rep. Mariannette Miller-Meeks (R-IA-2) spoke in support of the bill.
- This bill was forwarded to the full committee following a voice vote.
H.R. 9390, the Prices on the Wall Act (Rep. Mariannette Miller-Meeks (R-IA-2)), to require hospitals, ambulatory surgical centers, and labs to post the discounted cash price in dollar amount on the wall for each service they provide.
- Rep. Miller-Meeks (R-IA-2) spoke in support of the bill, highlighting the importance of physically seeing the prices.
- Full Committee Ranking Member Pallone expressed his concern that it will cause more confusion for consumers and could deter them from care. While he acknowledged the good intent behind the bill, he explicitly raised issues with the fact that the posted prices will not be what patients actually pay and that billing codes can be unclear.
- This bill was forwarded to the full committee following a voice vote.
H.R. 3514, Improving Seniors’ Timely Access to Care Act of 2025 (Reps. Mike Kelly (R-PA-16) and Suzan DelBene (D-WA-1)), to require plans to establish, and evaluate the implementation of, an electronic prior authorization.
- Reps. John Joyce (R-PA-13), Kim Schrier (D-WA-1), Miller-Meeks, Lizzie
- Fletcher (D-TX-7), and Troy Carter (D-LA-2) spoke in support.
- This bill was forwarded to the full committee following a voice vote.
H.R. 9392, the Medicare Advantage Cost Transparency Act (Reps. Diana DeGette (D-CO-1) and John Joyce (R-PA-13)), to require the inclusion of certain information in Medicare Advantage encounter data.
- Rep. Joyce spoke in support of the bill and emphasized the importance of including value- based contracting in this list of information to capture the full picture. He also shared the need for a uniform reporting standard so the data is comparable across plan types.
- This bill was forwarded to the full committee following a voice vote.
H.R. 5243, to require each Medicare Advantage plan to submit eligibility for supplemental benefits, types of benefit categories offered, and data on utilization of and payments for such benefits (Rep. Jennifer McClellan (D-VA-4)).
- This bill as amended was forwarded to the full committee following a voice vote.
H.R. 9395, the Transparency in Medicare Advantage Steering Act (Rep. Alexandria Ocasio-Cortez (D-NY14)), to require Medicare Advantage organizations to share the amount and form of compensation paid to an agent or broker, along with the total amount of compensation paid to agents and brokers.
- This bill was forwarded to the full committee following a voice vote.
Washington is looking forward to a three-day weekend, as the nation gears up to celebrate 250 years of independence. However, there’s still a lot going on in the health care space. Medicare payment rules are being reviewed, House conservatives are making a push for health care reform in Reconciliation 3.0, and a 340B reform discussion draft has been published. So, let’s get into it. Welcome to the Week Ahead!
The Administration
Minds may be focused on summer, but it’s also rules season for the Centers for Medicare and Medicaid Services (CMS) as the agency works with the Office of Management and Budget (OMB) to release both proposed and finalized versions of several of the payment rules for calendar (CY) and fiscal year (FY) 2027. The CY27 Physician Fee Schedule proposed rule and CY27 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule are usually released in early to mid-July. We expect the CY27 PFS to acknowledge the statutory end of the 2.5% pay bump that Congress provided for physicians through the 2025 reconciliation bill, which is certain to prompt renewed calls from physician groups for both a short-term fix and longer-term reform of how the PFS rate is calculated. It will also be important to see if CMS responds to concerns about other controversial provisions of the CY26 PFS final rule, such as the -2.5% efficiency adjustment and the reductions to the practice expense portion of the reimbursement calculation for facility-based services. For the CY27 HOPPS proposed rule, we expect CMS to continue its multi-year phase-out of the inpatient-only list and propose a larger 340B conversion factor offset than CY26. CMS may also propose differentiated skin-substitute rates based on Food and Drug Administration (FDA) regulatory categories. These expectations are based on CMS comments included in the CY26 HOPPS final rule fact sheet. CMS and OMB are also still working on releasing the FY27 Hospital Inpatient Prospective Payment System (IPPS) final rule and the FY27 Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) final rule, which we expect in late July-early August.
Meanwhile, speculation continues as to who will be President Trump’s next nominee for Food and Drug Administration (FDA) Commissioner. A few names have reportedly emerged as finalists, although the White House has not confirmed this report. Reported finalists include Dr. Heidi Overton, who currently serves as deputy director of the White House Domestic Policy Council, Dr. Jeffery Vacirca, who is the CEO of the board of New York Cancer & Blood Specialists, and Stephen Ferrara, who previously served as Chief Medical Officer for the Navy and the Central Intelligence Agency (CIA). A June 24 report from RBC Capital Markets also listed John Crowley, CEO of the Biotechnology Innovation Organization (BIO), and current acting commissioner Kyle Diamantas as top candidates. Crowley’s appointment would be a big win for pharmaceutical companies and could go a long way in repairing the administration’s relationship with the sector.
In other nomination news, President Trump has announced Chris Klomp will be nominated for Deputy Secretary of Health and Human Services. Klomp has been on the rise after becoming Chief Counselor of HHS in February. This role will require Senate confirmation, but he has already cleared one hurdle: approval from Senate HELP Committee Chair Bill Cassidy (R-LA), who has expressed his support on social media.
The Senate
The Senate has left town until July 13, but right before packing his bags, Senate HELP Committee Chair Cassidy dropped a discussion draft to reform the 340B Drug Pricing Program. The proposed changes aim to prevent duplication of drug discounts, create reporting requirements on how 340B revenue is being used, and impose a sliding fee scale for low-income patients. The discussion draft shows that Chair Cassidy is not taking it easy despite his lame duck status. However, it’s unclear how much progress he can make before his term ends.
The House
Whispers about Reconciliation 3.0 are getting louder again, this time focusing on potential health policy inclusions. House Freedom Caucus members authored a letter to Speaker of the House Mike Johnson (R-LA-4) calling for “health care freedom reforms”, such as expanding access to health savings accounts (HSAs) and strengthening federal price transparency requirements. However, like everything else in the House these days, passage of a third reconciliation bill is complicated by President Trump’s demands to pass his election bill, the SAVE America Act. Speaker Johnson has proposed including a grant program in a third reconciliation package to fund state efforts to implement portions of the SAVE America Act. While this could preemptively meet the Byrd Rule in the Senate, which requires measures passed through reconciliation to have a budgetary impact, it may leave both hardline conservatives (who want full passage of the SAVE America Act) and certain Senate Republicans (who have voiced concerns about the SAVE America Act) unsatisfied.
Additionally, the Ways and Means Committee is looking to take another run at a bill requiring additional transparency from nonprofit hospitals, after it was pulled from a previous Committee markup. The legislation, as previously proposed, would require nonprofit hospitals to meet new transparency requirements when filing their Form 990 with the Internal Revenue Service each year. Our conversations on the Hill indicate that Committee Republicans are still working through the process of incorporating stakeholder feedback and hope to move on it soon.
Also on our radar, the House Majority Leader’s schedule for the week of June 29 incudes H.R. 5347, the Health Care Efficiency Through Flexibility Act. This bill would preserve existing accountable care organization (ACO) quality reporting collection types through performance year (PY) 2029, bar CMS from deeming an ACO’s data “unrepresentative” solely because some participants couldn’t submit via the chosen collection type (subject to certain requirements) and establish an optional digital quality measure pilot (PY 2028–2032) with reporting relief for participants.
Looking ahead: House Democrats are gearing up for future possibilities if they retake the chamber in the midterm elections. Party leadership has established 5 Cost of Living working groups to discuss possible policies to address affordability, which will be the number 1 priority if Democrats win back control of the chamber, according to Minority Leader Hakeem Jeffries (D-NY-8). The Health working group will be headed by Reps. Alexandria Ocasio-Cortez (D-NY-14) and Terri Sewell (D-AL-7) and aims to develop policy recommendations to lower health care costs and expand access. The materials produced by the working group will likely form the backbone of Democratic health policy and signal the changes Democrats will try to enact if they regain control of the House.
House Health Care Hearings This Week
- House Veterans’ Affairs Health Subcommittee legislative hearing on health care legislation
- House Financial Services markup of the Securing Facilities for Mental Health Services Act
- House Education and Workforce HELP Subcommittee hearing on direct contracting
There You Have It
The 4th of July is almost here, and with it the United States is celebrating the 250th anniversary. About 45% of Americans were also alive for the 200th celebrations. If you were there, let us know what you remember about it. Make it a great week!
On June 24, 2026, the Joint Economic Committee held a hearing to examine ways to prevent health care fraud and instances where health care programs are not being used as intended. Chairman David Schweikert (R-AZ-1) encouraged Committee members and witnesses to focus on tangible solutions to the issue. Members discussed ways to reduce health sector consolidation, prevent fraudulent actions from health plan brokers, and leverage technology to reduce fraud in federal health programs.
OPENING STATEMENTS
WITNESS TESTIMONY
- Dr. Brian Blase, Founder and President, Paragon Health Institute – Testimony
- Dr. David Meyers, Associate Professor of Health Services, Policy, and Practice, Associate Director of the Center for Advancing Health Policy Through Research, Vice Department Chair, Brown University – Testimony
- Dr. Chris Pope, Senior Fellow, Manhattan Institute – Testimony
- Jessica Tillipman, J.D., Associate Dean for Governmental Procurement Law Studies, Government Contracts Advisory Council Distinguished Professorial Lecturer in Law, George Washington University Law School – Testimony
MEMBER DISCUSSION
Consolidation
Multiple members expressed concerns about the level of consolidation and vertical integration in the health system. Reps. Don Beyer (D-VA-8) and Victoria Spartz (R-IN-5) asked for solutions to prevent consolidation as well as to unwind some of the current consolidation. Dr. Meyers expressed that it would be extremely challenging to unwind current consolidation but gave recommendations to prevent further consolidation. These recommendations include structural separation, preventing health plans from acquiring more providers, and changing incentives, such as site neutral payment reforms, risk adjustment, and the medical loss ratio, to prevent encouraging more consolidation.
Brokers
Democrats on the Committee raised concerns about health insurance brokers. Ranking Member Maggie Hassan (D-NH) and Rep. Beyer wanted to understand how to prevent brokers from acting fraudulently. Dr. Meyers highlighted registering brokers, requiring stricter beneficiary understanding and consent for their plan of choice, and changing incentives for brokers to enroll a beneficiary in a specific plan by standardizing plan payments to brokers and making brokers a fiduciary of the beneficiary. Ms. Tillipman was supportive of reevaluating the specific incentives that create issues with brokers, but she cautioned the committee to not create broad disruptions.
Medicare and Medicaid
Chairman Schweikert suggested that a universal solution to fraud in Medicare Advantage would be to move to a capitated payment model, with a longer enrollment period. Dr. Meyers shared that a capitated model could be beneficial for improving plan incentives to support beneficiaries but cautioned that there would need to be a way for beneficiaries to leave the plan before their enrollment was over.
Rep. Spartz raised concerns about the high levels of automatic funding for federal health programs and questioned if Congress should provide more regular oversight. Dr. Blase agreed, sharing that the Medicare Part B trust fund will soon reach insolvency which will force Congress to address spending.
Sen. Amy Klobuchar (D-MN) asked each witness to share the top bipartisan reform Congress should focus on. Dr. Blase highlighted the need for the federal government to recoup funds states have spent on improper Medicaid payments. Dr. Pope shared that there needs to be increased documentation of services received by enrollees in Medicaid managed care plans.
Technology
Chairman Schweikert was curious if there was a universal data solution to reduce fraud. Dr. Blase shared that while artificial intelligence may play a role, he would recommend Congress focus on reducing the distortions that occur due to government payment policies. Dr. Meyer suggested that developing a better plan finder tool could be beneficial, as well as overlaying technology on top of other larger reforms to increase their impact. Sen. Klobuchar was interested in technological improvements but highlighted that many government computer systems need system wide upgrades to bring them into the modern age. Ms. Tillipman agreed, sharing that public systems need widespread upgrades to allow them to share information broadly, which can reduce duplicate work and decrease fraud.
Americans pay roughly 3x more for brand-name prescription drugs than people in comparable wealthy countries. The Trump administration has made it a top priority to combat this through Most Favored Nation (MFN) drug pricing, a model that pegs what Americans pay for drugs to the lowest or 2nd-lowest price paid by comparably developed countries. On May 12, 2025, Trump signed an Executive Order directing his administration to aggressively pursue MFN pricing on both a direct-to-consumer level and within Medicaid and Medicare. In the year since, the administration has rolled out TrumpRx and 3 CMMI Center for Medicare and Medicaid Innovation (CMMI) models: GENEROUS, GLOBE, and GUARD. This blog examines the intricacies of these initiatives and the remaining questions around overlap, participation, and transparency.
TrumpRx
The centerpiece of Trump’s drug pricing rollout is a portal comprised of opaque deals with 17 drug manufacturers. Announced in September 2025 and launched on February 6, 2026, TrumpRx is a direct-to-consumer comparison portal for cash-paying, uninsured Americans. The site routes patients to discounted brand-name drug prices and connects users to GoodRx, Cost Plus Drugs, and Amazon Pharmacy for generics, though it does not directly fill prescriptions itself.
Trump signed the 1st MFN deal with Pfizer in September 2025, and 16 other manufacturers have signed on since. In exchange for Section 232 tariff exemption, each agreed to participate in TrumpRx, offer MFN pricing to state Medicaid programs, and invest in U.S. manufacturing infrastructure and/or research and development. Infrastructure commitments have ranged from $10 billion from Boehringer Ingelheim to $100 billion from AbbVie, but with the agreements shielded from public view, it is impossible to assess whether the figures represent new investment or repackaged spending.
GENEROUS
Building on the TrumpRx deals, the Centers for Medicare and Medicaid Services (CMS) announced the Generating Cost Reductions for U.S. Medicaid (GENEROUS) model in late 2025 as the Medicaid arm of the Executive Order. The model benchmarks Medicaid drug prices against international comparators, with participation voluntary for both states and manufacturers. The model launched in January 2026 on a rolling basis as states and manufacturers continue to apply.
Following the April 2, 2026 announcement of increased Section 232 tariffs, CMS extended the manufacturer application deadline to June 11, 2026, citing an opportunity for small and mid-sized manufacturers to participate, while states now have until September 10, 2026 to apply. CMS claims overwhelming manufacturer interest but has yet to disclose which states or manufacturers have signed participation agreements. The only manufacturers known to be participating in GENEROUS are those who have already signed deals with the administration.
GLOBE and GUARD
The mandatory counterparts to the voluntary MFN framework, GLOBE (Global Benchmark for Efficient Drug Pricing) and GUARD (Guarding U.S. Medicare Against Rising Drug Costs), were announced in December 2025. GLOBE applies to Medicare Part B and runs from October 1, 2026 through October 1, 2031, while GUARD applies to Medicare Part D and runs from January 1, 2027, through December 31, 2031. Both extend through 2033 for rebate invoicing and reconciliation. Under both models, manufacturers pay rebates when drug prices exceed international benchmarks, with the explicit goal of lowering out-of-pocket costs for Medicare enrollees.
Unlike GENEROUS, participation is mandatory for all manufacturers of high-spend, single-source drugs and biological products, making GLOBE and GUARD the most structurally significant of the four initiatives.
Despite the mandatory framework of GLOBE and GUARD, questions remain about the participation of manufacturers who signed TrumpRx deals. There are no formal exemptions for them in the proposed rules, but concerns have been raised that these manufacturers may be exempt. If true, the voluntary deals would function not just as a pricing mechanism, but as an escape from the mandatory models.
How the Pricing Works
The pricing methodology compounds the problem, as the four initiatives use different strategies. TrumpRx and GENEROUS benchmark against the second-lowest price among G7 countries, Denmark, and Switzerland, adjusted by GDP per capita. Under GENEROUS, manufacturers are also required to self-report country-specific net prices to CMS, a feature that effectively redefines MFN as the second-lowest country-specific net price rather than the lowest visible list price.
GLOBE and GUARD offer two calculation methods, with CMS applying whichever produces the higher benchmark. Under Method I, CMS calculates the lowest country-level average price across 19 Organization for Economic Co-operation and Development (OECD) reference countries, adjusted by GDP per capita. Under Method II, manufacturers voluntarily submit their own across-country average net prices, which CMS then adjusts the same way. Because Method II produces a volume-weighted average rather than the single lowest price, it tends to yield a higher benchmark than Method I, meaning manufacturers who self-report are subject to a less favorable calculation. The structure is designed to incentivize disclosure, but it also means the benchmark patients benefit from depends on whether manufacturers choose to participate in a process that typically works against them, an uncertain foundation for a pricing model.
What Congress Is Saying
Despite broad political acknowledgment that Americans pay too much for prescription drugs and strong voter support for codifying MFN, MFN pricing has failed to generate consensus anywhere on Capitol Hill.
Democrats have primarily focused on concerns about a lack of transparency. On March 3, 2026, Senate Finance Ranking Member Ron Wyden (D-OR) and six Democratic colleagues wrote to 11 manufacturers demanding disclosure of which drugs are covered, the MFN price for each, and whether those prices undercut existing Medicaid net pricing. Senator Wyden has also worked with the ranking members of House Committees with jurisdiction over health care to send letters to the Department of Health and Human Services (HHS) and Merck requesting qualifying drug lists, pricing agreement disclosures, and benchmark calculations. In addition to the letters, Senate Democrats introduced S. 4355 demanding HHS release the deal documents.
Republican, for their part, are not aligned on MFN:
- At an April 22, 2026 Senate Finance hearing, Sen. Tillis (R-NC) dismissed the deals as a “simplistic” answer to a complex problem.
- Rep. Mast (R-FL-21) has actively championed them as recently as May 20, 2026, saying MFN is a “chance for our communities to finally get some relief.”
- H.R. 7837, the Most Favored Patient Act, introduced by Rep. Meuser (R-PA-9), would mandate MFN pricing for manufacturers who decline voluntary agreements by December 2028, and has not attracted any cosponsors as of June 22, 2026.
- Reps. Luna (R-FL-13) and Biggs (R-AZ-03) joined Reps. Kaptur (D-OH-09) and Khanna (D-CA-17) to introduce the Global Fairness in Drug Pricing Act, which would codify Trump’s deals into permanent law.
On June 2, 2026, CMS Administrator Dr. Oz acknowledged that without congressional action, the MFN deals expire when the administration does, a vulnerability the administration itself has been forced to concede. Days later, TrumpRx announced an expansion to more than 800 drugs, scaling a program whose durability is still unresolved.
What Stakeholders Are Saying
The debate over MFN pricing has exposed a striking disconnect: voters overwhelmingly want lower drug prices, but the policies designed to deliver them have drawn sharp opposition from the very groups meant to benefit.
A June 2025 national poll commissioned by the Pharmaceutical Reform Alliance captured just how urgent the issue feels to ordinary Americans. Conducted by Republican pollster Adam Geller, the survey of 1,000 registered voters found that 51% had difficulty affording prescriptions, 84% held the pharmaceutical industry most responsible for high prices, and 85% supported “America First” reforms to align U.S. drug prices with the lowest prices paid internationally. That frustration has translated into broad political support: 78% of voters backed President Trump’s May 12th Executive Order, including 61% of Democrats.
But public appetite for change has not meant public confidence in these specific policies. That gap shows up most clearly with TrumpRx. A Fortune analysis found that even discounted prices would remain out of reach for low-income patients, and that the portal’s digital-only design effectively locks out elderly, rural, and offline users, precisely the populations the broader effort claims to help. The program may ultimately serve a narrow slice of users who are uninsured, tech-savvy, and cash-ready, functioning less as a check on rising prices than as cover for them.
The Alliance for Aging Research raised the alarm early, warning that both GLOBE and GUARD would tie Medicare drug payments to prices set by foreign governments. The Alliance pointed to CMMI’s own projections showing the GLOBE model alone would increase healthcare costs for seniors by $3.6 billion. The Partnership to Improve Patient Care took the critique further, arguing that importing foreign price controls means importing the QALY frameworks those systems use to assign value to human life, the same formulas Medicare has explicitly banned over concerns about discrimination against elderly and disabled patients. The GLOBE and GUARD proposed rules drew over 20,000 comments during their public comment period, with sentiment running overwhelmingly negative, commenters characterizing both models as policies more likely to restrict access than deliver savings.
Conservative groups echoed those objections. On February 12, 2026, Americans for Tax Reform and more than 50 allied organizations urged Congress to reject codification of the deals, arguing that tariff-backed pricing concessions are government price controls by another name.
The Bottom Line
The administration has built an ambitious two-track MFN framework, but both tracks share the same vulnerability. The voluntary deals depend on a political priority that can change, and a tariff threat that can be lifted, and without congressional action, they expire with the administration. The mandatory models have structural teeth, but if manufacturers with White House agreements can claim exemption from GLOBE and GUARD, the framework loses its most consequential targets. What connects both problems is transparency. The agreements are private, the benchmarks rely heavily on manufacturer self-reporting, and the savings are unconfirmed. Until these things change, it is impossible to assess whether this framework represents a durable shift in drug pricing policy or simply the appearance of one.
