Insights

In June 2026, federal regulators and lawmakers continued their efforts to improve drug affordability through targeted reforms. These recent developments will primarily impact pharmaceutical manufacturers, managed care organizations, and pharmacy benefit managers (PBM) serving Medicare Part D program members. PBMs, Medicare Advantage organizations, and Part D sponsors should monitor these changes in the interest of maintaining compliance and providing input on regulatory proposals that may influence their business operations or compensation structures in the future.

Two significant recent developments illustrate the Trump administration’s increasing focus on policing of hospital contracting practices that limit health plan network design flexibility. On June 16, 2026, the U.S. Department of Justice (DOJ) Antitrust Division and Ohio attorney general filed a proposed consent decree resolving their civil antitrust suit against OhioHealth. (Prior Alert) Two days later, the White House Council of Economic Advisers (CEA) released a memorandum quantifying the potential economic effects of a broader ban on the types of contracting restrictions at issue in the OhioHealth case and the DOJ's parallel suit against NewYork-Presbyterian. This alert updates our prior coverage of the OhioHealth complaint and summarizes both developments.

On April 10, 2026, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (2026 CMS Interoperability Standards and Prior Authorization for Drugs, or CMS-0062-P) outlining the agency’s plans to impose new interoperability requirements on payors participating in certain Medicare and Medicaid programs. As described by the agency in a recent press release, the proposed rule “builds on” prior rulemaking by clarifying and enhancing interoperability requirements for payors’ prior authorization processes, specifically those associated with coverage requests for pharmaceutical therapies.