Bipartisan Break Up Big Medicine Act Targets Vertical Integration in Health Care

Senators Elizabeth Warren (D, Massachusetts) and Josh Hawley (R, Missouri) introduced the Break Up Big Medicine Act, legislation aimed at prohibiting the joint ownership of health insurers, pharmacy benefit managers (PBMs), providers, and wholesalers to reduce health care costs and restore competition.¹

The bipartisan measure addresses what lawmakers characterize as structural conflicts of interest that enable vertically integrated corporate health care giants to point business toward their own affiliates while avoiding oversight, ultimately driving up prices for patients and employers.

“There’s no question that massive health care companies have created layers of complexity to jack up the price of everything from prescription drugs to a visit to the doctor,” Warren said in a statement.¹ “The only way to make health care more affordable is to break up these health care conglomerates. Our bill would be a monumental step towards ending the stranglehold that corporate giants have on our broken health care system.”

The Break Up Big Medicine Act would prohibit parent companies from simultaneously owning medical providers or management services organizations alongside PBMs or insurers. Similarly, companies that own prescription drug or medical device wholesalers would be barred from owning medical providers or management services organizations. Violators would face automatic penalties if they fail to comply within 1 year of the law's enactment, including profit disgorgement and forced asset sales.

The legislation comes amid growing concerns about consolidation in the health care industry. In the US, 3 PBMs currently manage 80% of prescription drug claims,² and 3 wholesalers control 98% of prescription drug distribution.³ These entities are often vertically integrated, meaning a single parent company can own every component of the health care supply chain, from the insurer that pays for services to the provider that delivers them.

Warren and Hawley's previously introduced Patients Before Monopolies Act would prohibit a parent company of a PBM or insurer from owning a pharmacy business.⁴ The Break Up Big Medicine Act would extend the provisions to additional business lines within the health care sector.¹

“Americans are paying more and more for health care while the quality of care gets worse and worse,” Hawley said in a statement.¹ “In their quest to put profits over people, Big Pharma and the insurance companies continue to gobble up every independent care provider and pharmacy they can find. Working Americans deserve better. This bipartisan legislation is a massive step towards making health care affordable for every American.”

To enforce the bill’s provisions, the Federal Trade Commission (FTC), HHS, Department of Justice (DOJ), state attorneys general, and private parties would be empowered to bring lawsuits against companies in violation. The FTC and DOJ would also have the authority to review and block future transactions that would recreate prohibited conflicts of interest.

“For decades, policymakers in both parties have incentivized health care consolidation, resulting in Big Medicine behemoths that exploit conflicts of interest to drive costs up, quality down, and independent providers out of business,” Emma Freer, senior policy analyst for health care at the American Economic Liberties Project, said in a statement.¹ “This is why we launched the Break Up Big Medicine initiative last year and are proud to support the Break Up Big Medicine Act, which will eliminate these conflicts of interest while restoring power over our health care system to patients and the providers who care for them.”

References

1. Warren, Hawley introduce bipartisan bill to break up big medicine. Elizabeth Warren. February 10, 2026. Accessed February 12, 2026. https://www.warren.senate.gov/newsroom/press-releases/warren-hawley-introduce-bipartisan-bill-to-break-up-big-medicine

2. Freed M, Cubanski J, Williams E, Pestaina K. What to know about pharmacy benefit managers (PBMs) and federal efforts at regulation. KFF. February 9, 2026. Accessed February 12, 2026. https://www.kff.org/other-health/what-to-know-about-pharmacy-benefit-managers-pbms-and-federal-efforts-at-regulation/

3. Rooke-Ley H, Sachs RE. Pharmaceutical wholesalers—under-the-radar middlemen? N Engl J Med. 2025;393(14):1358-1360. doi:10.1056/NEJMp2507855

4. Warren, Hawley, Harshbarger, Auchincloss introduce bipartisan bill to cut drug costs, rein in pharmacy benefit managers (PBMs). Elizabeth Warren. December 11, 2024. Accessed February 12, 2026. https://www.warren.senate.gov/newsroom/press-releases/warren-hawley-harshbarger-auchincloss-introduce-bipartisan-bill-to-cut-drug-costs-rein-in-pharmacy-benefit-managers-pbms