Bipartisan Legislation Aims to Address Consolidation and Vertical Integration of PBMs

On Tuesday, Senators Elizabeth Warren (D, Massachusetts) and Josh Hawley (R, Missouri) introduced the Break Up Big Medicine Act, according to a news release.^1,2

In a move aimed at dismantling the corporate control on American health care, this bipartisan legislation seeks to address rampant consolidation and vertical integration that proponents argue have driven up prices and stifled competition, particularly affecting independent pharmacists and medical providers.

For pharmacists, the bill represents a potential turning point in a market where 3 pharmacy benefit managers (PBMs) currently manage 80% of prescription drug claims and 3 wholesalers control 98% of drug distribution.

“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. The only way to make health care more affordable is to break up these conglomerates,” Warren said in the release.¹ “Our bill would be a monumental step towards ending the stranglehold that corporate giants have on our broken health care system.”

READ MORE: Q&A: PBMs, Community Pharmacy’s Next Move Following PBM Reform Signing

The proposed law draws inspiration from the 1933 Glass-Steagall Act, which famously separated commercial and investment banking.³ If passed, it would create a blockade between conflicting drug distribution business lines, effectively prohibiting a single parent company from owning both a medical provider and a PBM or insurer.

This structural separation aims to eliminate the inherent conflicts of interest that occur when a company both pays for health care services and sets the prices for them at the same time. Under these new rules, parent companies of prescription drug wholesalers would also be barred from owning medical providers or management services organizations.

How This Bill Can Significantly Benefit the Health Care System

The impact on independent pharmacy operations has been a central theme in the push for this legislation. Since 2019, nearly 4000 independent pharmacies have shuttered their doors as massive conglomerates steer patients toward their own affiliated pharmacies and subsidiaries. These Big Medicine giants—including major companies like UnitedHealth Group, CVS Health, and Cigna—have created layers of complexity that allow them to squeeze independent practices out of business while increasing prices for patients, according to KFF Health News.⁴

Mark Cuban, founder of Cost Plus Drugs, has also lauded the bill as a “no-brainer,” urging President Trump to put his weight behind the measure to lower costs for the public.³

This legislative push arrives as health care affordability reaches a crisis point for many Americans, with insurance costs consuming more than 10% of median family income in 19 states.⁴ The tension in the current system is further evidenced by ongoing contract disputes, such as the fight between Mount Sinai Health System and Anthem Blue Cross Blue Shield over hundreds of millions in unpaid claims, which has left patients uncertain about their access to critical cancer therapy.

Additional Goals of Bipartisan Lawmakers

Beyond the legislation, other lawmakers are also exploring systemic changes, including potential overhauls to the Medicare physician payment system to address the concerns of medical societies seeking a successor to current incentive programs.

The Break Up Big Medicine Act includes rigorous enforcement mechanisms to ensure compliance. Companies found in violation of these ownership restrictions would be required to divest conflicting subsidiaries within 1 year of the bill’s enactment.^1,3 Failure to comply would trigger automatic penalties, including the forced sale of assets and the disgorgement of profits.

The Federal Trade Commission and the Department of Justice would be empowered to oversee these separations and block future mergers that would recreate these consolidated structures.

Although Congress has recently used other legislative vehicles, such as government funding packages, to rein in executive power and protect existing funding allocations, the Warren-Hawley bill targets the private sector’s structural foundations.⁴

Supporters argue that by decoupling the entities that pay for care from those that provide it, the industry can restore the checks and balances necessary for an efficient system where healthcare workers make decisions based on medical judgment rather than profit motives. For the pharmaceutical industry, this shift is intended to reestablish PBMs as a counterweight to drug manufacturers, rather than entities that favor higher prices due to vertical incentives.

Ultimately, the legislation seeks to ensure that independent pharmacies and medical practices can compete on a level playing field.⁵

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

READ MORE: What the Newest Landmark PBM Reform Means for the Pharmacy Industry

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REFERENCES

1. Warren, Hawley introduce bipartisan bill to break up big medicine. Office of US Senator Elizabeth Warren of Massachusetts. 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. Break Up Big Medicine Act. Office of US Senator Elizabeth Warren of Massachusetts. February 10, 2026. Accessed February 12, 2026. https://www.warren.senate.gov/imo/media/doc/break_up_big_medicine_act.pdf

3. Mishra R. Mark Cuban urges Trump to “put his weight behind” Josh Hawley, Elizabeth Warren’s “Break Up Big Medicine Act.” Benzinga. February 11, 2026. Accessed February 12, 2026. https://www.benzinga.com/markets/equities/26/02/50533973/mark-cuban-urges-trump-to-put-his-weight-behind-josh-hawley-elizabeth-warrens-break-up-big-medicine-act

4. Bipartisan ‘Break Up Big Medicine’ bill aims to end health care consolidation. KFF Health News. February 2026. Accessed February 12, 2026. https://kffhealthnews.org/morning-breakout/bipartisan-break-up-big-medicine-bill-aims-to-end-health-care-consolidation/

5. Break Up Big Medicine. Breakupbigmedicine.com. Accessed February 12, 2026. https://www.breakupbigmedicine.com/