Health Law Daily Wrap Up, HOUSE NEWS: House passes appropriations bill with health extenders, PBM reform, (Jan 23, 2026)
Organizations Mentioned:U.S. House of Representatives
By Sheila Lynch-Afryl, J.D., M.A.
The legislation extends COVID-era Medicare telehealth flexibilities through December 31, 2027.
The U.S. House of Representatives passed an appropriations package that funds HHS through September 30. The Consolidated Appropriations Act, 2026 (H.R. 7148), which passed 341 to 88, also extends key health provisions, including COVID-era telehealth flexibilities and Medicare rural hospital programs, and institutes pharmacy benefit manager (PBM) reform. It does not, however, address Affordable Care Act (ACA) enhanced premium subsidies that expired at the end of 2025 or President Donald Trump’s recently unveiled health affordability framework. The Senate is expected to vote on the legislation next week.
The bill extends the following health provisions:
COVID-era Medicare telehealth flexibilities through December 31, 2027;
the Hospital at Home waiver through September 30, 2030;
the Medicare-Dependent Hospital and low-volume programs through December 31, 2026;
delaying $8 billion in cuts to Medicaid disproportionate share hospitals until fiscal year 2028;
payment cuts and reporting requirements under the Medicare clinical laboratory fee schedule;
bonuses under the ambulance fee schedule through December 31, 2027;
physician fee schedule 1.0 floor for work geographic practice cost indices through December 31, 2026; and
the temporary inclusion of authorized oral retroviral drugs as covered Part D drugs through December 31, 2026.
Section 6223 of the bill addresses pharmacy access by requiring prescription drug plan sponsors to permit any pharmacy that meets the standard contract terms to participate as a network pharmacy and requiring that contract terms be “reasonable and relevant.” Section 6224 aims to increase PBM accountability by prohibiting PBM reimbursement from being tied to a manufacturer’s list price and increasing transparency and reporting.
In addition, the bill provides for Medicare coverage of multi-cancer early detection screening tests. It also requires Medicare Advantage plans to maintain accurate provider lists and off-campus hospital outpatient departments to have their own identification numbers and provide their own attestations.
MainStory: NewsStory FederalLegislationNews HealthCareReformNews HouseNews ReimbursementNews BillingNews CMSNews CopayNews CoverageNews DrugBiologicNews DSHNews HealthReformNews HospiceNews IPPSNews LaboratoryNews MedicaidNews MedicaidPaymentNews OPPSNews PhysicianNews PartANews PartBNews PartCNews PartDNews PrescriptionDrugNews RuralNews FedTracker HealthCare