Insights

On February 11, 2026, the Senate Special Committee on Aging held a hearing to examine how regulatory challenges for physicians can create undue burdens. There was bipartisan support about the need to address the issues of physician burnout, administrative burdens, and prior authorization reforms.

OPENING STATEMENTS

• Chairman Rick Scott (R-FL)

WITNESSES

• Alma Littles, MD, Dean and Chief Academic Officer, Florida State University College of Medicine – Testimony

• Lee Gross, MD, Founder, Epiphany Health Direct Primary Care – Testimony

• Jeffrey Smith, CPA, MBA, FACMPE, CGMA, Incoming Board Chair of Medical Group Management Association (MGMA) and Chief Executive Officer Piedmont HealthCare, PA – Testimony

• Corey Fiest, JD, MBA, Co-founder and Chief Executive Officer, Lorna Breen Heroes’ Foundation – Testimony

MEMBER DISCUSSION

Sen. Ashley Moody (R-FL) expressed concerns that the exodus of providers from traditional practices to direct primary care will lead to care not being accessible to all patients. Sen. Moody asked what Dr. Gross would recommend to ensure that patients served by traditional practices continue to have access to quality and affordable care. Dr. Gross responded that, in his view, a physician who leaves practice completely would be seeing zero patients, but a physician who moves to a direct primary care model is still seeing patients.

Ranking Member Gillibrand (D-NY) requested that Mr. Fiest explain how the wellbeing guide developed by his organization reduces physician burnout. Mr. Fiest shared that clinicians who practice in systems that have implemented the guide have experienced a decrease in time spent outside of direct patient care and increased levels of wellbeing, both of which have decreased burnout symptoms. Ranking Member Gillibrand also asked what the expected impact of the Wasteful and Inappropriate Service Reduction (WISeR) Model will be on administrative burden and burnout. Mr. Smith expressed concerns that the model will increase the need for prior authorizations and lead to more patients seeing delayed or denied care. Mr. Smith continued that these effects would lead to sicker patients and contribute to physician burnout. Ranking Member Gillibrand was also interested in how a mismatch in medical training and actual practice can drive burnout. Dr. Gross argued that current medical education does not teach practice management skills, which are crucial for physicians who want to practice outside of a large hospital system.

Sen. Raphael Warnock (D-GA) questioned what the effect of additional workforce shortages will have on health professionals. Mr. Fiest shared that reductions in staff will impact access, quality, and cost of health care as physicians need to take on greater amounts of administrative work. Sen. Warnock wondered if increasing the number of residency spots, through bills such as S.2439, could be part of a solution. Mr. Smith said that yes, any increase in slots would help, but they also need to incentivize residents to practice general primary care. Sen. Warnock questioned if the costs associated with medical school are dissuading students from entering the profession. Dr. Littles shared that costs are a large factor for students as they must support themselves through schooling. Dr. Littles also stated that students will make decisions on what type of medicine to practice based on salaries for different specialties.

Sen. Angela Alsobrooks (D-MD) asked what impactful, preventive system reforms could address the root causes of burn out. Mr. Fiest noted that reducing administrative burden, improving nursing safety, and preventing acts of violence would make the workload more manageable for providers. Sen. Alsobrooks then asked how the current prior authorization system contributes to physicians’ burdens and impacts the delivery of care. Mr. Smith explained that prior authorizations are delaying care, with more patients seeking care in urgent care or emergency rooms. Mr. Smith also highlighted that many administrative workers are experiencing high levels of burnout due to the workload and addressing administrative burdens would reduce turnover.

Chairman Rick Scott (R-FL) questioned how increased documentation requirements may reduce the desire to work in underserved areas. Dr. Littles shared that rural communities often do not have access to many electronic health record systems due to the high costs, and for systems that do have them, the complexity and lack of interoperability have a negative impact on the practice experience. Chairman Scott wanted to understand the general structure of Dr. Gross’s day. Dr. Gross shared that he has a greater capacity for same-day patients, which reduces his need to refer patients to the emergency room or specialists. Dr. Gross also has more time to manage his practice.

On February 11, 2026, the House Energy and Commerce Health Subcommittee held a hearing to consider how to reduce health care costs by examining the prescription drug supply chain. This hearing was the Subcommittee’s second on health care affordability, and reports indicate there will be additional hearings focusing on other parts of the health care sector. Overall, Republicans and Democrats both agreed that prescription drug costs are too high and that there is too much consolidation in the prescription drug industry, especially among pharmacy benefit managers (PBMs). However, Republicans and Democrats on the Committee also focused on familiar partisan arguments regarding the impact of the Inflation Reduction Act and recent actions by the Trump administration, including TrumpRx, on prescription drug costs. Unsurprisingly, witnesses from different parts of the pharmaceutical industry sought to highlight actions they have taken to reduce costs and to place blame on other stakeholders, including hospitals and insurance companies, as well as on programs such as the 340B program.

OPENING STATEMENTS

• Health Subcommittee Chair Morgan Griffith (R-VA-9)

• Full Committee Ranking Member Frank Pallone (D-NJ-6)

WITNESS TESTIMONY

• Lori M. Reilly, Esq., Chief Operating Officer, PhRMA – Testimony

• John F. Crowley, President and CEO, Biotechnology Innovation Organization – Testimony

• John Murphy, President and CEO, Association for Accessible Medicines – Testimony

• David Marin, President and CEO, Pharmaceutical Care Management Association – Testimony

• Angie Boliver, President and CEO, Healthcare Supply Chain Association – Testimony

• Chester “Chip” Davis, Jr., President and CEO, Healthcare Distribution Alliance – Testimony

• James Gelfand, President and CEO, The ERISA Industry Committee – Testimony

• Douglas Hoey, CEO, National Community Pharmacists Association – Testimony

• Rachel E. Sachs, Professor of Law, Washington University in St. Louis – Testimony

MEMBER DISCUSSION

PBM Consolidation and Vertical Integration

Multiple Health Subcommittee members on both sides of the aisle expressed concerns about reports that the 3 largest PBMs control 80% of the market and about PBMs’ frequent vertical integration. Members expressed skepticism about Mr. David Marin’s arguments that there is competition within the industry and that this competition leads to lower prices for patients. Other witnesses who did not represent PBMs were also highly critical of certain PBM practices. A number of Subcommittee members praised the inclusion of PBM reforms in the recently passed appropriations legislation, but others said more needed to be done.

Medicare Negotiation Vs. Most-Favored Nation Deals and TrumpRx

The biggest partisan divide centered on whether Medicare negotiation, as passed under the Inflation Reduction Act, or the most-favored-nation deals negotiated by the Trump administration and presented on TrumpRx, represented the better way to address concerns about drug costs. Republicans, including Health Subcommittee Chair Morgan Griffith (R-VA-9) and Rep. Michael Rulli (R-OH-6), praised the Trump administration for its efforts to secure lower drug prices for the American people through TrumpRx. Republicans, including full Committee Chair Brett Guthrie (R-KY-2), criticized the Inflation Reduction Act for disrupting the Medicare Part D marketplace.

On the other hand, Democratic members, including full Committee Ranking Member Frank Pallone (D-NJ-6) and Health Subcommittee Ranking Member Diana DeGette (D-CO-1), argued that the deals from the Trump administration lacked transparency. As a result, they argued, there is no way to verify how effective they are at lowering drug costs. These members asked Subcommittee Chair Guthrie if he would be willing to work with them to determine the details of these deals. He said he would as long as that didn’t blow up the deals in question. Democrats such as Rep. Marc Veasey (D-TX-33) criticized TrumpRx for listing drugs that could actually be found for cheaper using manufacturer or other coupons. Democratic members such as Reps. Pallone and Jennifer McClellan (D-VA-4) criticized Republicans for including carve-outs for orphan drugs from the Medicare negotiation program in the reconciliation bill and called for expanding Medicare price negotiation to the commercial market.

Federal Government’s Role in Drug Development and Approval

Members on both sides of the aisle expressed interest in the federal government’s role in drug development and approval. Rep. Dan Crenshaw (R-TX-2) asked Ms. Reilly about efforts to modernize the regulatory framework when it comes to the approval of new therapies. She responded that a transparent regulatory environment and strong IP protections are necessary to support the development of innovative therapies, including gene and cell therapies. On the other side of the aisle, Democratic members questioned witnesses about the impact of reductions in force (RIFs) at the Food and Drug Administration (FDA) and concerns about reports of politicalization within the agency. All of the witnesses who were asked about the impact of RIFs and politicization expressed concerns about the negative impact on drug development and approval. Democratic members such as Reps. Pallone and Kim Schrier (D-WA-8) expressed specific concerns about the FDA not reviewing Moderna’s flu vaccine due to vaccine skepticism. Other Democratic members criticized Republicans for not speaking out about cuts to basic research at agencies such as the National Institutes of Health (NIH). Rep. Guthrie countered that the NIH received a half-billion-dollar increase in the appropriations legislation.

Other Topics

• Rep. Griffith asked Mr. Crowley if they should start looking at insurance companies as fiduciaries and hold them liable for harm they cause to patients. Mr. Crowley agreed that this is a good idea to provide more protection for patients.

• Reps. Gus Bilirakis (R-FL-9) and Kevin Mullin (D-CA-15) asked Mr. Crowley about rare disease drug development. In response to a question from Rep. Bilirakis on how we can continue to encourage investment in finding cures for rare diseases without burdening patients, Mr. Crowley said we need to reduce the complexity of the clinical trial system, modernize the FDA, and ensure medications are affordable and accessible.

• Rep. Troy Balderson (R-OH-12) asked Mr. Hoey to elaborate on specific challenges rural pharmacies face when negotiating with PBMs, specifically with take-it-or-leave-it contracts for reimbursements. Mr. Hoey explained that PBMs hold all the leverage, forcing pharmacies to accept contracts that pay them less than it costs to acquire the drug; as a result, 5,000 pharmacies have closed in the last 4 years.

• Rep. Cliff Bentz (R-OR-2) asked Ms. Sachs how AI might help analyze the pharmaceutical space. She noted the FDA’s approval of AI-enabled medical devices and the use of AI to streamline clinical trial enrollment. She also suggested using AI to help the subcommittee look through and summarize the vast amounts of information in the pharmaceutical space. She also warned of an AI arms race between providers and insurers that could deny care through prior authorization.

• Rep. Rick Allen (R-GA-12) asked Mr. Gelfand if his proposed bill, H.R.5509, the Safe Step Act, would help hold insurers accountable for increasing the use of step therapy, leading to nonadherence and access issues. Mr. Gelfand explained that reforming step therapy makes sense and that it should be electronic, timely, and aligned with medical management.