Congress Approves Healthcare Package Addressing Drug Costs and Hospital Transparency
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Congress passed a package of healthcare bills on January 20, 2026, aiming to lower prescription drug costs, increase hospital billing transparency, and bolster pediatric cancer research. The legislation includes provisions to limit the power of pharmacy benefit managers (PBMs) and expand Medicare coverage.
Pharmacy Benefit Manager (PBM) Reform
The legislation directly addresses the role of Pharmacy Benefit Managers (PBMs), which negotiate drug prices with manufacturers and manage prescription drug benefits for health plans. PBMs act as intermediaries between drug manufacturers, insurance companies, and pharmacies, and have faced criticism for a lack of transparency and potential conflicts of interest.
The new law prohibits PBMs from engaging in spread pricing, a practice where they charge health plans more for a drug than they reimburse pharmacies, pocketing the difference. It also requires PBMs to disclose more information about their pricing and rebates to health plans and employers.
Example: The Congressional Budget Office (CBO) estimates that curbing spread pricing will save health plans and beneficiaries approximately $24 billion over the next ten years. CBO Report on PBM Reform
Hospital Billing Transparency
The package includes measures to increase transparency in hospital billing practices, addressing concerns about surprise medical bills and opaque pricing. Hospitals will be required to provide patients with clear, upfront estimates of their costs for scheduled procedures.
The legislation builds upon the No Surprises Act, which already protects patients from unexpected out-of-network bills. This new component focuses on providing more comprehensive price information *before* care is received.
evidence: According to a January 18, 2026, statement from the centers for Medicare & medicaid Services (CMS), the new rules will require hospitals to post standard charges online in a machine-readable format, making it easier for patients to compare prices. CMS Press Release
Pediatric Cancer Research
The legislation reauthorizes and expands funding for pediatric cancer research programs. Pediatric cancer remains a leading cause of death by disease among children,and research funding is critical for developing new treatments and improving survival rates.
The bill specifically allocates $500 million over five years to support research into rare pediatric cancers, which often receive less attention than more common forms of the disease.
Example: The National Cancer Institute (NCI) will receive increased funding to support collaborative research projects focused on pediatric cancer, as outlined in the legislation. NCI Statement on Pediatric Cancer Funding
Medicare coverage Expansion
The healthcare package expands Medicare coverage to include certain preventative services and chronic disease management programs. This aims to improve access to care for seniors and reduce healthcare costs in the long run.
Specifically, the legislation expands Medicare coverage for multi-cancer early detection (MCED) tests, which can screen for multiple types of cancer together. The tests are designed to detect cancer at earlier stages, when it is indeed more treatable.
Evidence: The Medicare Payment Advisory Commission (MedPAC) recommended expanding coverage for MCED tests in its January 2026 report to Congress, citing the potential for improved health outcomes. MedPAC January 2026 Report
