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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.
Washington returns after a long weekend dealing with the fallout of President Trump’s last-minute decision to halt consideration of his nominee for Director of National Intelligence and his signing of an agreement to end the war with Iran. Vice President Vance arrived in Switzerland on Sunday to lead the next round of negotiations with Iranian officials with the goal of brokering an interim deal addressing Tehran’s nuclear program. Meanwhile, federal health care officials are working on reviewing some of their past work, and Congress continues its work on some familiar items even as the midterms grow ever closer. So, let’s get into it. Welcome to the Week Ahead!
The Administration
Hopefully, Centers for Medicare and Medicaid Services (CMS) officials tasked with managing the Medicare Advantage (MA) star ratings system enjoyed their time off because they are gearing up to recalculate the 2026 Star ratings and 2027 Quality Bonus Payments (QBP). A federal judge recently ruled that the agency relied on improper data and failed to follow the appropriate regulatory process for adding measures in determining the star rating for Clover Health. The real pressure is on insurers seeking a reconsideration of their QBP ratings, as they must notify CMS of their intent to resubmit a bid or to opt out of resubmission by 11:59 PM Pacific Daylight Time on June 22, 2026.
Meanwhile, the Congressional Budget Office (CBO) is taking another look at the impacts of the No Surprises Act. Specifically, CBO is considering how the independent dispute resolution (IDR) process may have had unanticipated impacts. According to the agency, published reports have indicated that providers are winning over 80% of cases that move through the process and are being awarded much higher payments than expected. As a result, CBO is requesting additional research that uses more recent data to understand network participation, pricing, and ownership structure trends. CBO is also looking for research on the arbitrators’ decision-making process and how health care markets continue to evolve. This call for research is the latest in the struggles that have plagued both the Biden and Trump administrations when it comes to implementing the No Surprises Act. Being able to get the balance right would be a win for the administration, but it could easily intensify the fighting between providers and insurers.
The Senate
President Trump is scheduled to attend Wednesday’s Republican Steering Committee lunch, where he is expected to continue to champion the SAVE America Act. His appearance on the Hill comes at a time when tensions are running high with the lapse of FISA and concerns about the Iran talks.
Eyes are turned to Louisiana, as voters head to the polls to cast their ballots in the Senate primary runoff. On the Republican side, voters have the choice between Rep. Julia Letlow (R-LA-5) and state Treasurer John Fleming. Not on the ballot is Senator and HELP Committee Chairman Bill Cassidy (R-LA), who came in 3rd in the May primary. His loss will leave a health leadership hole. However, Rep. Letlow, backed by President Trump and Health and Human Services Secretary Robert Kennedy, has embraced the Make America Healthy Again (MAHA) mantra, so health care has continued to feature heavily in this race. If Rep. Letlow wins, it would be a big win for the MAHA movement.
Health Care Hearings This Week
- June 24: Senate Indian Affairs Committee nomination hearing to consider Mark Cruz to be Director of the Indian Health Service
- June 24: Joint Economic Committee hearing on combatting health care fraud
The House
The Improving Seniors’ Timely Access to Care Act (H.R. 3514) has reached 290 cosponsors, which now allows for it to be considered outside of the standard Committee process. This longtime bipartisan bill proposes reforms for prior authorization under Medicare Advantage plans. We are still expecting the bill to follow the Committee process as a courtesy based on our conversations on the Hill. Regardless of whether the bill goes to Committee or not, this is a milestone for a bill that has lingered despite strong bipartisan support.
The House Energy and Commerce Committee’s work will take center stage this week. Chair Guthrie (R-KY) and Ranking Member Pallone (D-NJ) are expected to announce a successful bipartisan agreement on legislation surrounding children’s online safety. Thresholds for parental consent on data collection of minors have been lowered and mandatory disclosures when children interact with AI tools. The bill is expected to move through the lower chamber quickly. The Committee’s Oversight Subcommittee will convene June 25 to examine with testimony from Minnesota’s Medicaid Director, continuing House Republicans’ focus on fraud in federal health programs.
There You Have It
The World Cup is ongoing, and the United States has secured its spot in the round of 32 with its win against Australia. How do you think the US is stacking up? Let us know. Make it a great week!
Congress granted President Trump’s wish, just in time for his 80th birthday, by sending him the immigration enforcement reconciliation legislation he’s been asking for. Now, President Trump has a new wish, a third reconciliation package to include defense funding and the SAVE America Act. However, Congressional Republicans have differing views on the likelihood of making this wish come true. So, let’s get into it. Welcome to the Week Ahead!
The Administration
The grace period for hospital price transparency is over, according to a notice published on social media by the Department of Health and Human Services (HHS). According to the notice, HHS has sent warning letters to over 500 hospitals for noncompliance with price transparency requirements since enforcement went into effect on April 1, 2026. The notice and warning letters make it clear that the administration is trying to show that they are making strides in improving health affordability. However, it’s not clear from the notice what additional steps will be taken by the administration to ensure compliance.
On June 8, the District of Massachusetts vacated the Trump administration’s $100,000 fee on new H-1B applications as an unlawful tax. The administration appealed this, and it has been temporarily stayed until a ruling by the U.S. Court of Appeals for the 1st Circuit. That stay is conditioned on the administration filing a motion to stay no later than June 18, 2026. Whether this fee remains in place has implications for the health care workforce, as many foreign-born physicians, who often fill critical gaps in the health care system, rely on the H-1B visa pathway.
The Senate
Reconciliation 3.0 is off to a rocky start in the Senate as Republican leadership disagrees on whether it is possible at all. Senate Majority Leader John Thune (R-SD) shared that he remains open to the possibility, especially for additional military funding. On the other hand, Senate Appropriations Committee Chair Susan Collins (R-ME) and Senate Appropriations Defense Subcommittee Chair Mitch McConnell (R-KY) are more skeptical about 3.0, cautioning officials not to rely on a 3rd package to supplement lower funding levels during the normal appropriations process.
In non-reconciliation news, the first stage of the Democratic health care working groups has concluded. The three groups, focused on long-term care, health insurance, and prescription drugs, finished holding their open office hours and will next move to releasing Requests for Information and position papers on their topics according to our conversations on the Hill. These working groups are important to watch for what Democratic leaders may be looking to do if they retake the Senate in November.
Health Care Hearings This Week
The Senate Health, Education, Labor and Pensions (HELP) Committee is scheduled to consider several health care bills on June 17, spanning from organ transplants and drug competition to reauthorizing public health programs, most of which have House companions. Surprisingly absent from the list is S. 4189, the INSULIN Act, which would cap the monthly cost of insulin at $35 for patients with commercial insurance and was reportedly going to be included But don’t count it out yet, bill sponsor Sen. Jeanne Shaheen (D-NH) recently announced that the legislation has reached the 60-vote threshold for passage.
Also on the docket for June 17, the Senate Aging Committee will be holding a hearing on China’s impact on seniors’ health, finances, and security with Commissioners from the U.S.-China Economic and Security Review Commission. The Committee has already held multiple hearings on the security of the pharmaceutical supply chain and the dangers of reliance on foreign countries, including China. Based on this, we expect the topic to come up again at the upcoming hearing.
The House
The House is out until after the Juneteenth holiday, but Republican conversations about Reconciliation 3.0 are still happening. Measures targeting fraud in public health programs are still being viewed as a pay for by some members. However, House Energy and Commerce Health Subcommittee Chair Morgan Griffith (R-VA-9) told reporters that health care systems “need to adjust to the changes we’ve already made.” And then there are concerns from moderates and those in tight races about doing anything that could be seen as limiting access to benefits so close to the November midterms.
There You Have It
It was an exciting weekend for sports fans, as the NBA Finals and the Stanley Cup finals crowned their winners. Here at Chamber Hill Strategies, we have strong opinions about which games we preferred to tune in to. So, have you been watching hockey, basketball, or both? Let us know. Make it a great week!
