Highlights
- Congress passes the Consolidated Appropriations Act of 2026
- The Federal Trade Commission (FTC) settles with Express Scripts over business practices
- The federal government launches the TrumpRx program
- FiercePharma publishes “Top 10 Most Anticipated Drug Launches of 2026”
- The Centers for Medicare and Medicaid Services (CMS) announces drugs selected for third round of price negotiations
U.S. Food and Drug Administration (FDA) approvals and launches
- Oral Wegovy (semaglutide) is launched as an alternative to its injectable counterpart
- Zycubo (copper histidinate) is approved to treat Menkes disease, a rare genetic disorder
- Nereus (tradipitant) is approved as a prescription drug to prevent nausea and vomiting caused by motion sickness
News
Congress passes the Consolidated Appropriations Act of 2026
- The law contains a wide range of Pharmacy Benefit Manager (PBM) reforms that, among other mandates, require PBMs to pass through 100% of rebates received and provide plans with comprehensive reporting on a regular basis.
- Mandated reporting includes either semiannual or quarterly summaries detailing items such as a plan’s gross and net spending, manufacturer remuneration linked to a plan’s utilization, and steerage incentives directed towards PBM-owned pharmacies.
- The law also contains provisions regulating the frequency and scope of manufacturer rebate audits.
The Federal Trade Commission (FTC) settles with Express Scripts over business practices
- Settlement provisions include items such as:
- Curbing the preference of high wholesale acquisition cost (WAC) versions of drugs
- Enacting pricing that is less dependent on high list prices and rebate payments
- Onshoring of its group purchasing organization (GPO) Ascent from Switzerland to the United States
- The settlement cites an implementation date of January 1, 2028 for several mandates.
The Federal government launches the TrumpRx program
- The website facilitates access to direct-to-consumer programs to help cash-paying patients access discounts for certain drugs.
- GoodRx is a “core integration partner” for the program; enrollee card information is the same for each program.
FiercePharma publishes “Top 10 Most Anticipated Drug Launches of 2026”
- CagriSema, a combination drug featuring GLP-1 semaglutide, is listed as the most anticipated drug launch in 2026 and was submitted for FDA approval in December 2025.
- The second drug listed in FiercePharma’s Top 10 is orforglipron, a once-daily GLP-1 drug dosed orally.
The Centers for Medicare and Medicaid Services (CMS) announces drugs selected for third round of price negotiations
- Examples of popular drugs included in the third round of negotiations include Botox, Cosentyx, and Trulicity.
- Tradjenta, which had been subject to previous negotiations, was selected for renegotiation.
KFF polling highlights prior authorizations as the leading burden of receiving healthcare, outside of costs
- Roughly one in three insured adults reported the prior authorization process as their biggest healthcare burden outside of costs.
- Other highly reported complaints include setting appointments with healthcare providers, understanding bills, and finding providers contracted with their specific insurance provider.
Drug Channels summarizes “Big Three PBM” 2026 formulary changes
- Drug Channels notes that the amount of formulary exclusions plateaued for Caremark and Optum Rx but increased for Express Scripts.
- Private label biosimilars, defined as biosimilar products marketed by subsidiaries within the same umbrella company as each PBM, continue to drive adoption and coverage.
CMS publishes “National Health Expenditures 2024 Highlights”
- Retail prescription drug spend comprised 9% of total spend and increased 7.9% in 2024 compared to an increase of 10.8% in 2023.
- Healthcare spending among private health insurers increased 8.8% in 2024 compared to 11.2% in 2023, with much of this increase being related to increased enrollment.