Insights CenterEventsNews & Press Releases The PBM industry continues to evolve through legislative action, litigation, and voluntary industry changes. Below is a brief round-up of recent developments including new federal and state legislation targeting vertical integration, an ERISA preemption challenge to California’s PBM reform law, and a new pharmacy care model announced by Optum Rx. Congress is again targeting vertical integration in the insurance and PBM industries. The Patients Before Monopolies Act (PBM Act), first introduced in December 2024, was re-introduced in both chambers on May 13, 2026, with bipartisan sponsors. This bill follows the Break Up Big Medicine Act, a broader bill banning common ownership between insurers, PBMs, pharmacies, wholesalers, and a wide range of health care providers, which appears to have stalled in committee. The 2024 and 2026…

These funds will be returned to the person upon timely divestment. If the divestment deadline is missed, a divestiture trustee will be appointed with authority to sell the pharmacy. Broader Standing: Both the 2024 and 2026 versions of the bill authorize civil actions against those violating the law by the Inspector General of the Department of Health and Human Services, the DOJ Antitrust Division, the FTC, or a state attorney general. The 2026 bill, however, also adds a private right of action for any individual alleging damages as a result of a violation of the act. If the plaintiff in a civil action prevails, the court may award treble damages and attorney fees. These new features — the shortened divestment period, milestone guidance requirement, and private right of action — mirror the enforcement mechanisms that were included in the Break Up Big Medicine Act. At t…