WHAT HAPPENED
The post-CAA 2026 landscape is taking shape across three simultaneous fronts. First, PharmaVoice reported (Feb. 27) that with PBM reform now enacted, the pricing spotlight is swinging back toward drug manufacturers. Jesse Dresser of Frier Levitt warned that manufacturers must begin restructuring PBM contracts immediately because any fees tethered to list prices or percentages will be prohibited once the delink provisions take effect. Meanwhile, PCMA published a pointed memo (Feb. 3) arguing that with PBM reform complete, Congress should turn its attention to manufacturer practices including patent abuse, shadow pricing, and pay-for-delay tactics. The AJMC reported that Johns Hopkins researcher Ge Bai cautioned that patients may not see near-term savings because cost-sharing is still calculated on list prices, not net prices—meaning 100% rebate pass-through benefits plan sponsors, not patients directly.
ALSO THIS WEEK
Trump calls on Congress to codify MFN pricing in State of the Union
In his Feb. 24 State of the Union address, President Trump urged Congress to permanently codify the Most Favored Nation drug pricing agreements, telling Speaker Johnson and Majority Leader Thune directly to pass legislation. He touted TrumpRx.gov and claimed prices are down “300 to 600 percent.” However, Axios reported there are no signs of legislative activity on Capitol Hill to actually move codification forward. Meanwhile, 340B Report noted that PhRMA’s leadership responded by pushing PBM and 340B reform instead of MFN codification—a familiar deflection strategy that now carries less weight given that PBM reform is already law. Key gap: the administration still lacks clear legal authority to compel MFN pricing without congressional action, and the voluntary agreements are limited to cash-pay and Medicaid channels, excluding the commercial insurance market where most spending occurs.
Cigna/Evernorth quietly completes CarepathRx acquisition, reaching ~10% of US hospitals
STAT News broke (Feb. 26) that Cigna’s Evernorth health services division has completed its acquisition of CarepathRx, a hospital pharmacy that dispenses drugs to nearly 10% of U.S. hospitals. The deal was not formally announced—STAT discovered it through financial filings. Fierce Healthcare confirmed that Oregon regulators reviewed the deal and determined it would not materially increase Evernorth’s market concentration, though Evernorth already controls Express Scripts (PBM) and Accredo (specialty pharmacy). Industry analysts have noted the deal gives Evernorth indirect access to 340B economics—including discounted acquisition costs, revenue-sharing with hospitals, and increased manufacturer negotiating leverage. The timing is notable: Cigna deepens vertical integration into hospital pharmacy dispensing at the exact moment Congress has enacted PBM reform intended to increase transparency and reduce intermediary margin extraction.
DOJ backs AbbVie in challenge to Colorado’s 340B contract pharmacy access law
The Department of Justice filed a brief supporting AbbVie’s position that Colorado’s law prohibiting manufacturer restrictions on 340B contract pharmacy arrangements conflicts with federal law. This is the first time the Trump administration DOJ has directly intervened on the manufacturer side in state 340B contract pharmacy litigation. The filing follows AbbVie’s earlier successful challenge in Hawaii and ongoing suits by PhRMA against New Mexico’s contract pharmacy access law. Pattern emerging: the federal government is siding with manufacturers in state 340B cases while simultaneously proposing to move the entire 340B program from HRSA to CMS oversight in the 2026 budget—a coordinated strategy to centralize control over 340B economics at the federal level.
AJMC analysis maps five policy goals driving PBM reform implementation
AJMC published a comprehensive analysis (March 2) identifying five distinct policy objectives embedded in the CAA 2026 PBM provisions: transparency mandates, delinking compensation from drug prices, rebate pass-through requirements, pharmacy access protections, and scrutiny of vertical integration. The analysis notes that the CAA 2026 authorizes civil penalties of up to $10,000 per day for PBMs or plans that fail to meet transparency reporting requirements. KFF’s updated PBM reform brief (Feb. 9) estimates the provisions will reduce the federal deficit by $2.12 billion over 10 years, with $1.865 billion coming from increased oversight of PBMs working with employer health plans—signaling CBO expects the largest impact in the commercial market, not Medicare.
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