AJMC conference panelists warned this week that the CAA 2026 PBM delink rules were designed for a pricing environment that no longer exists — MFN agreements, IRA list-price cuts, and state affordability boards are dismantling the rebate architecture that the reforms were built to regulate. Meanwhile, the AHA is seeking full-court rehearing of the 4th Circuit’s West Virginia 340B ruling, PBM lobbyists are fighting the DOL’s commercial transparency proposal, and the FTC settlement opt-out loophole may fragment commercial PBM reform into a two-speed market. This week’s flash brief covers what market access teams need to model before the next reform cycle begins.