In early 2026, pharmaceutical companies have implemented list price increases on at least 350 branded medications in the US, up from around 250 at the same point in 2025. The median hike is approximately 4%, consistent with the prior year’s average, despite ongoing political pressure from the Trump administration, which secured “most favored nation” (MFN) pricing deals with 14 major drugmakers in late 2025 to align certain US prices with those in other developed countries.
These deals primarily affect Medicaid and cash-paying patients for specific drugs treating conditions like diabetes, arthritis, and cancer, but they do not broadly prevent list price increases, as companies often maximize list prices while offering rebates to insurers and setting separate discounts for direct sales.
Key examples of 2026 price increases include:
– – Pfizer, which leads with hikes on about 80 products, including a 15% increase on its COVID-19 vaccine Comirnaty, as well as rises on the cancer drug Ibrance, migraine treatment Nurtec, and COVID-19 therapy Paxlovid.
– – GSK with increases on around 20 drugs and vaccines, ranging from 2% to 8.9%.
– – Other notable hikes on vaccines for COVID-19, RSV, and shingles, plus some hospital drugs like morphine and hydromorphone (with increases exceeding 400% in certain cases).
At least five companies that signed Most Favored Nation deals – Pfizer, Sanofi, Boehringer Ingelheim, Novartis, and GSK – proceeded with these increases anyway, highlighting that the agreements address only a fraction of the factors driving high US drug costs (where patients pay nearly three times more than in other developed nations). Industry stakeholders predict continued single-digit annual rises through the end of Trump’s term, largely fueled by expensive new therapies for cancer, diabetes, obesity, and gene/cell treatments.
Currently efforts to regulate pharmacy benefit managers (PBMs) have accelerated at both federal and state levels, driven by bipartisan concerns over their role in inflating drug costs, reducing pharmacy access, and prioritizing profits through practices like spread pricing (where PBMs charge payers more than they reimburse pharmacies) and rebate retention.
Congress is on the verge of passing significant PBM reforms as part of a bipartisan $1.2 trillion appropriations “minibus” package released on January 20, 2026, which funds agencies like HHS through fiscal year 2026. This deal revives elements of stalled 2024-2025 proposals, including those from Senate Finance Committee leaders Ron Wyden (D-OR) and Mike Crapo (R-ID), and is expected to be signed into law to avert a government shutdown. Key provisions include:
– – Medicare Part D Reforms (Effective 2028-2029): Bans PBMs from pocketing manufacturer rebates or kickbacks, requiring full pass-through to plan sponsors or patients. Delinks PBM compensation from drug prices or utilization, shifting to flat service fees to reduce incentives for favoring high-cost drugs. Reinforces “any willing pharmacy” rules to prevent exclusion of independent pharmacies from networks.
– – Medicaid Changes (Effective Immediately or 2026): Bans spread pricing entirely and mandates direct payments to pharmacies.
– – Commercial Market Requirements: Mandates rebate pass-throughs to employers and updates pharmacy network standards for fairness.
– – Enforcement and Studies: Allocates $188 million to CMS for oversight, requires a government study of PBM business models, and updates the National Average Drug Acquisition Cost (NADAC) survey for accurate pricing benchmarks.
– – Other Bills: The PBM Reform Act of 2025 (H.R. 4317), introduced in July 2025, remains in the “introduced” stage but influenced the appropriations package. Separate proposals like the Patients Before Monopolies Act (introduced in 2024 and reintroduced in 2025) seek to prohibit PBM-pharmacy co-ownership by major players like UnitedHealth, CVS, and Cigna, with divestiture timelines, but have not advanced beyond committee.
These reforms target the “Big Three” PBMs (CVS Caremark, Express Scripts, and OptumRx), which control about 80% of the market and are often vertically integrated with insurers and pharmacies. A July 2024 FTC report highlighted how these entities pay affiliated pharmacies up to 40 times more for certain drugs than competitors, exacerbating costs.
All 50 states now have PBM regulations, with 26 enacting new laws in 2025 alone, focusing on licensing, transparency, and curbing predatory practices. As of January 1, 2026, several bans and requirements are in effect:
– – Spread Pricing Bans: Implemented in states like California (via Senate Bill 41) and multiple Medicaid programs, prohibiting PBMs from retaining the difference between payer charges and pharmacy reimbursements.
– – PBM-Pharmacy Ownership Bans: Arkansas led with Act 624 in April 2025, barring PBMs from owning pharmacies; it’s under federal injunction but inspired similar laws in at least five other states (e.g., Massachusetts with transparency mandates under Senate Bill 3012).
– – Transparency and Reporting: Over 23 states require real-time drug pricing disclosure and rebate reporting; 12 have prescription drug affordability boards to review costs. Illinois and others ended “predatory practices” like clawbacks.
– – Other Measures: Bans on gag clauses (preventing pharmacists from discussing cheaper options), limits on audits, and “any willing pharmacy” protections are common.
States like Arkansas and California are testing models that could influence national policy, though PBMs are litigating aggressively, with some laws delayed by courts. Projections for 2026 indicate continued state experimentation, potentially filling federal gaps.