Insights

On February 20, 2026, the Department of Justice’s Antitrust Division (DOJ) and Ohio Attorney General (Ohio AG) sued OhioHealth Corporation (OhioHealth), alleging that OhioHealth had unlawfully restrained trade in the market for general acute care inpatient hospital services in the Columbus metropolitan statistical area and the narrower Central Columbus area, respectively. The DOJ and Ohio AG allege violations of Section 1 of the Sherman Act, as well as the Valentine Act (Ohio’s antitrust statute), claiming that OhioHealth leveraged its market power to impose contractual restrictions that blocked payors from working with competing health systems to design “budget-conscious” lower-cost health plans.

On February 10, 2026, California enacted Senate Bill 25 (“SB 25”), known as the California Uniform Antitrust Pre-Merger Notification Act. The new law takes effect on January 1, 2027, making California the third state—following Washington (effective July 27, 2025) and Colorado (effective August 6, 2025)—to implement a “mini-HSR” regime modeled after the Uniform Antitrust Pre-Merger Notification Act (“UAPNA”). The legislation reflects the growing state-level focus on merger oversight, and it signals California’s continuing intent to increase early pre-merger scrutiny and concurrent review of transactions with federal authorities.

Earlier this month, California enacted Senate Bill 763 (“SB 763”). The legislation amends the state’s long-standing antitrust statute, the Cartwright Act, to increase both criminal and civil maximum penalties for corporations and individuals.  California Attorney General Rob Bonta, whose office is responsible for enforcing the Cartwright Act and stands to benefit from any civil penalties recovered under the new law, sponsored the bill.

The deadline for Department of Health and Human Services (“HHS”) to notify approved manufacturers of acceptance into the 340B Rebate Model Pilot Program has passed, and stakeholders across the healthcare industry should start planning for compliance and operational changes. The Model Pilot Program may also face legal challenges that could delay or disrupt implementation.

California recently enacted two laws instituting new restrictions and requirements for health care transactions. On October 6, Governor Newsom signed SB 351, which codifies elements of the state’s corporate practice of medicine doctrine and strengthens restrictions against private equity, hedge fund, and other private investor control of health care organizations and operations. On October 11, Newsom signed AB 1415, which expands the scope of parties and relevant transactions that require pre-transaction notice to the state’s Office of Health Care Affordability (OHCA). Both laws are intended to provide the State of California greater oversight of transactions involving health care entities, and raise additional hurdles for parties seeking to acquire or sell health care operations in the state,[1] consistent with a broader trend across the country. The key points of each of the California laws are summarized below:

On April 17, 2025, Arkansas recently became the first state to enact broad restrictions on pharmacy benefit managers (“PBMs”) owning retail pharmacies within the state.

The Fifth Circuit vacated the FTC’s Combatting Auto Retail Scams (CARS) Rule in January of this year, finding that the FTC failed to follow the correct administrative procedures when it promulgated the regulation.

Growing focus on antitrust enforcement at the federal level in recent years has been accompanied by a similar trend at the state level. Notably, multiple states have enacted or are considering enacting various legislative or regulatory changes that would create new regulatory requirements for businesses and make antitrust suits significantly easier for state attorneys general and private plaintiffs. These include new pre-transaction notice requirements, as well as the expansion of existing state antitrust statutes to cover more types of conduct while shifting the burden and expense of litigation from plaintiffs to defendants. In several cases, states have expressed a clear intent to increase enforcement related to the private equity and healthcare industries specifically.

With the coming of the new presidential administration, state antitrust enforcement is poised to intensify. We expect both Republican and Democratic Attorneys General (AGs) to actively pursue antitrust investigations and litigation. They will fill in where the U.S. Department of Justice and Federal Trade Commission reduce focus but are also sure to work, including on a bipartisan basis, with their federal counterparts. Below, we explore how state AGs are likely to shape the antitrust landscape in the coming four years, and the areas where we anticipate significant enforcement activity.

With the increase in state-federal collaboration, now is the time to ensure that your company is in the best position to engage with and address potential regulatory enforcement actions. In light of the uptick in intergovernmental investigative and enforcement collaboration, namely among federal agencies such as the Department of Justice (DOJ), and individual state authorities like state attorneys general offices (AGs), AGs are growing their enforcement capacity and increasing their activity in areas that have historically been left to federal agencies.

Last week the New Jersey State Attorney General (AG) Matthew J. Platkin announced the creation of a new division: the Antitrust Litigation and Competition Enforcement Section (ALCES) within the Division of Law (DOL). The permanent and stand-alone section is based out of the DOL’s Newark office and is intended to reinforce the state’s capacity for robust antitrust protection. This marks yet another effort by a state AG to increase antitrust resources and focus on both large and small antitrust issues to promote fair and competitive markets.