PBM Reforms, Restoration of Science Cuts Seen in $1.2T Spending Deal for 2026

Reforms to practices by pharmacy benefit managers (PBMs) were included in the $1.2 trillion spending package that received final passage in the US House of Representatives on February 3, 2026, following a brief partial government shutdown after US Senate passage.

The 71-29 Senate vote on January 30, 2026, came with an agreement to fund only 2 weeks of spending for the US Department of Homeland Security, allowing passage of 5 bills to fund other agencies through September 30, 2026. The US Department of Health and Human Services (HHS) spending bill touched on several priorities of community cancer care providers, including a schedule to move toward site-neutral payments and greater transparency in hospital billing.

The head of the American Cancer Society praised the legislation’s recognition that funding research for cures remains a national priority, and he praised the work of American Cancer Society Cancer Action Network (ACS CAN) volunteers in the restoration of funds cut in early 2025.¹

“ACS CAN is grateful that Congress worked together to bring these cancer-fighting provisions across the finish line,” Shane Jacobson, CEO of the American Cancer Society and American Cancer Society Cancer Action Network, said in a statement. “They represent real progress for patients, survivors, and families facing cancer every day. We thank all members, especially House and Senate appropriators, for recognizing the urgency of sustained investment in cancer research, prevention, and access to care.”¹

For the Community Oncology Alliance (COA), the legislation represents both a celebration of seeing some long-sought priorities cross the finish line and recognition that new threats to the health of practices remain.

“Reining in PBM abuses is a lifesaving measure for patients with cancer. For too long, these middlemen have profited off the backs of Americans with cancer by undermining patient care and leaving pharmacy and medical deserts in their wake,” said Ted Okon, MBA, executive director of COA, who began the crusade against PBM abuses nearly a decade ago.²

“The Community Oncology Alliance has long been supporting meaningful, bipartisan PBM reform, and we are encouraged by this important milestone of Congress finally passing legislation to address PBM abuses. However, this is just the start because PBMs are very adept at finding ways to profit while harming patients in the process. Congress needs to do more, and we stand ready to work with Congress to advance legislation that further reins in PBMs and protects patients.”

However, COA noted that other priorities remain unresolved. Of greatest urgency are elements of the Inflation Reduction Act that community practices say will starve them of revenue and shut down practices, due to the way Medicare has tied reimbursement to Part B drug pricing.

COA is also working to undo a 2023 CMS legal interpretation that bars community practices with on-site pharmacies from delivering prescriptions or allowing a caregiver to pick them up.³ In addition, the Trump administration has opted to address market distortions created by the 340B program not in legislation, but through a rebate model pilot program run by the Health Resources & Services Administration.⁴

Elements of the legislative package include the following:

The appropriation for HHS is $116.8 billion for fiscal year 2026, an increase of $210 million over 2025 and $33 billion more than the Trump administration sought. The bill also rejects proposed reorganizations of the National Institutes of Health (NIH) and even increases funding for biomedical research, STAT News reported.⁵

“Congress has essentially rejected the president’s very dramatic cuts,” Joanne Padrón Carney, chief government relations officer for the American Association for the Advancement of Science, told NBC News before Trump signed the legislation late February 3. “In past years, we might not consider flat funding to be a success, but considering how we’re operating this past year, I think we’re quite pleased.”⁶

The challenge now is dealing with the depleted infrastructure for carrying out publicly funded sciences, as leaders at many key agencies, such as NIH, the National Cancer Institute (NCI), and the FDA, have left government. A January 2026 report in Nature calculated that 25,000 scientists and personnel were gone from agencies that oversee science, from the NIH and NCI to the National Science Foundation and beyond, with budget cuts totaling $32 billion across the government. It remains to be seen whether funding alone can restore what agencies have lost, observers say.⁷

As an example, the legislation restores cuts to the CDC, bringing the embattled agency to flat funding at $9.1 billion, compared with the $4 billion figure the administration proposed. However, the news comes amid findings that the CDC has not been updating key databases for infectious disease reporting that are vital to public health officials and researchers.⁸

The legislative package folded in a bill that calls on Medicare to fund multicancer early detection (MCED) testing starting in 2028, which drew applause from advocates for equity in precision medicine.⁹
“With the signing of the MCED Screening Coverage Act, we are opening the door to a new era in how cancer is detected and ultimately prevented,” Jody Hoyos, CEO of the Prevent Cancer Foundation, said in a statement.⁹ “This law aligns our health care system with the pace of scientific innovation and brings us one step closer to a future where more cancers are found earlier—when treatment is more effective, and lives can be saved.”

After bipartisan efforts going back to the Biden administration,¹⁰ the legislation calls for new requirements on PBMs. It would bar them from linking payments to drug prices in Medicare Part D while boosting transparency. In commercial plans, the bill forces PBMs to pass through 100% of rebates to employer-sponsored plans. Pharmacies that seek to be part of a PBM network must be granted a reasonable contract. PBMs now face stronger reporting requirements, and expanded audit authority promises to shed light on PBM fees and payment structures.^2,5

Work by COA and others has shown how PBM practices have contributed to the loss of many rural and independent pharmacies, and COA praised the progress seen in the legislation. “These provisions reflect nearly a decade of sustained advocacy by COA and its members to expose opaque PBM business practices and document how they raise costs, restrict access to care, and destabilize independent community oncology practices,” the group said in a statement.²

The American Hospital Association praised the delay of cuts to Medicaid Disproportionate Share Hospital (DSH) payments until 2028.¹¹ Cuts of $8 billion a year were scheduled annually under legislation that took effect October 1, 2025.¹² These payments ensure the viability of safety-net hospitals, which care for higher-than-average percentages of low-income, uninsured, and Medicaid-insured patients. It is expected these hospitals may see higher patient volumes, due to Congress’ failure to extend tax credits that lowered premiums under the Affordable Care Act.

For more than a decade, large health systems have bought up independent practices that could not compete amid rising costs of technology and administrative requirements. Medicare and other insurers typically pay hospitals more because their facilities offer higher levels of care. However, smaller independent practices have complained that this reimbursement structure puts them at a disadvantage as competitors bill as part of 1 system. Starting in 2028, providers on separate campuses would be required to bill with separate National Provider Identifier numbers with the intent of eliminating the practice of overbilling by affiliates.¹³

An extension of pandemic-era Medicare telehealth flexibilities, which were previously extended through January 30, 2026, would extend through December 31, 2027. These technically lapsed as the final House vote was pushed to February 3, 2026. Extensions for hospital-at-home will continue through 2030.¹¹ Groups including the Cancer Support Community/Gilda’s Club had engaged with members to urge Congress to extend telehealth options.¹⁴

References
1. ACS CAN applauds passage of key provisions in appropriations package that demonstrate cancer remains a national priority. News release. American Cancer Society Cancer Action Network. February 3, 2026. Accessed February 3, 2026. https://www.fightcancer.org/releases/acs-can-applauds-passage-key-provisions-appropriations-package-demonstrate-cancer-remains
2. Congress takes important step on PBMs, telehealth, and Medicare in government funding bill. News release. Community Oncology Alliance. February 3, 2026. Accessed February 4, 2026. https://mycoa.communityoncology.org/news-updates/press-releases/2026-CAA-bill-release
3. Mullangi S, Jain AK, Wilfong L, Schleicher S. New federal guidance makes it harder for patients with cancer to access drugs. JCO Oncol Pract. 2024;20(5):610-613. DOI: 10.1200/OP.23.00691
4. 340B rebate model pilot program. Health Resources & Services Administration. Updated January 2026. Accessed February 3, 2026. https://www.hrsa.gov/opa/340b-model-pilot-program
5. Oza A, Wosen J. House and Senate appropriators endorse NIH budget increase, reject Trump’s proposed cuts. STAT News. January 20, 2026. Accessed January 30, 2026. https://www.statnews.com/2026/01/20/nih-funding-deal-trump-cuts-rejected-budget-boosted-415-million/
6. Bush E. Trump tried to gut science research funding. Courts and Congress have rebuffed him. NBC News. February 3, 2026. Accessed February 3, 2026. https://www.nbcnews.com/science/science-news/trump-science-research-funding-cuts-congress-rebuffed-rcna256793
7. Kozlov M, Tollefson J, Garisto D. US science after a year of Trump. Nature. January 20, 2026. Accessed February 1, 2026. https://www.nature.com/immersive/d41586-026-00088-9/index.html
8. Jacobs JW, Booth GS, Brewer NT, Freilich J. Unexplained pauses in Centers for Disease Control and Prevention surveillance: erosion of the public evidence base for health policy. Ann Intern Med. Published online January 27, 2026. doi:10.7326/ANNALS-25-04022
9. Prevent Cancer Foundation celebrates landmark passage of MCED Screening Coverage Act. News release. Prevent Cancer Foundation. February 3, 2026. Accessed February 2026. https://preventcancer.org/news/prevent-cancer-foundation-celebrates-landmark-passage-of-mced-screening-coverage-act/
10. Jeremias S. In wake of Express Scripts suit, FTC takes on 3 largest PBMs. Am J Manag Care. 2024;30(Spec 11):SP802.
11. House passes appropriations package for health care funding, extends key health care provisions. American Hospital Association. January 22, 2026. Accessed February 1, 2026. https://www.aha.org/news/headline/2026-01-22-house-passes-appropriations-package-health-care-funding-extends-key-health-care-provisions
12. Kraus B. Medicaid DSH cuts are here: what safety-net hospitals can do to protect cash flow today. Cedar. October 1, 2025. Accessed February 1, 2026. https://www.cedar.com/blog/medicaid-dsh-cuts-safety-net-hospital-strategies-protect-cash-flow/
13. Krause JR, Fee BC, Wink LA, Kizyte R. Legislative update: Congress set to resurrect separate NPI and attestation requirements for off-campus hospital outpatient departments. Hall Render. January 27, 2026. Accessed February 1, 2026. https://hallrender.com/2026/01/27/legislative-update-congress-set-to-resurrect-separate-npi-and-attestation-requirements-for-off-campus-hospital-outpatient-departments/
14. Take action: support extended access to telehealth services. Cancer Support Community. Accessed February 3, 2026. https://www.cancersupportcommunity.org/telehealth-modernization-act