Raise a glass!
If you thought Congress couldn't get anything done anymore, they've surprised us.
Congress has passed a sweeping health funding package that keeps major healthcare programs up and running, extends telehealth access some more, and rosins up their bow to take direct aim at pharmacy benefit managers — better known as PBMs — the powerful middlemen in the drug pricing system who've been keeping prices bloated.
It's not a "forever and a day" thing, however. The bill funds the Department of Health and Human Services through the end of September and helps avoid a prolonged government shutdown.
But the oomph for Seniors may well be what it does behind the scenes.
Smart Senior Daily Staff
PBM reforms are the headline
PBMs have had a target on their back for a while, with independent pharmacists, cancer doctors, and patient advocates arguing that they inflate drug prices, squeeze small pharmacies, and limit patient access to care.
Those groups are celebrating the bill’s new oversight and transparency rules, saying they could slow pharmacy closures and reduce so-called “pharmacy deserts,” especially in rural and underserved areas.
Greedy? You decide. Recent federal investigations — including a 2025 Federal Trade Commission report — pulled back the curtain, showing that the largest PBMs generated $7.3 billion in revenue from markups on specialty generic drugs between 2017 and 2022. Some of those markups drove prices up hundreds — even thousands — of percent.
PBM industry groups, however, strongly disagree. They warn the changes could actually raise prescription drug costs and point the finger at drugmakers, arguing that drugmakers — not PBMs — are the real drivers of high prices.
They might be right. And that debate isn’t going away. But Congress clearly decided it was time to intervene and get something done — even if, for now, it’s just a band-aid.
Smart Senior Daily Staff
Telehealth and hospital-at-home programs also get a lifeline.
The bill extends Medicare telehealth flexibilities for multiple years, allowing patients to keep using virtual visits without strict geographic limits. It also provides a five-year extension for the “hospital-at-home” program, which lets eligible patients receive hospital-level care safely at home instead of in a facility.
Healthcare providers say these extensions bring much-needed stability. Without them, millions of seniors, rural patients, and people with mobility challenges could have lost access to care they now rely on.
Hospitals and rural care get support — with some tradeoffs.
The package also eliminates planned Medicaid cuts that would have hit safety-net hospitals and extends funding for rural hospitals and community health centers. Hospital groups welcomed the financial relief but raised concerns about new paperwork and reporting requirements that could increase administrative burden.
Bottom line
For now, healthcare services remain uninterrupted, telehealth stays available, and Congress has taken its strongest step yet to rein in drug-pricing middlemen. All good on those fronts.
Now, the question is whether these reforms actually lower costs. That will depend on how they’re implemented — and whether lawmakers build on them or fold like a cheap suit under industry pressure.
Disclaimer: This article is for informational purposes only and does not constitute medical, legal, or financial advice. Healthcare policies, drug pricing rules, and coverage options can change, and individual circumstances vary. Readers should consult their healthcare providers, insurance plans, or qualified professionals for advice specific to their situation.
