When President Trump signed H.R. 7148, the Consolidated Appropriations Act, 2026, it did more than end the four-day partial shutdown. The Act also includes a number of reauthorizations and new policies that have been advocated by patients, healthcare professions, and innovative healthcare companies.
Bill Signing of H.R. 7148 (Screenshot: https://www.whitehouse.gov/wire/)
H.R. 7148 includes five full-year spending bills and a two-week extension of funding for the Department of Homeland Security. Like many large funding packages, the Act includes reauthorization of existing programs and new policies and programs.
Heath and Health Innovation Programs Reauthorized
Medicare Telehealth Coverage
Medicare telehealth coverage has been renewed for two years, extending pandemic-era flexibilities through December 31, 2026, or early 2027 based on latest budget developments, following a temporary lapse in early 2026. These extensions allow patients to receive care from home, maintain audio-only options, and prevent the immediate return to strict pre-COVID rural-only requirements.
Pediatric Priority Review (PPRV) program
The PPRV program incentivizes the development of treatments for rare pediatric diseases at no cost to taxpayers, providing hope for families affected by devastating conditions who often previously had no options.
John F. Crowley, President and CEO of the Biotechnology Innovation Organization (BIO) stated:
“The passage of the Mikaela Naylon Give Kids a Chance Act is a bipartisan victory for children and families living with rare diseases. We thank the bill’s House and Senate cosponsors and the countless patient advocates for their unwavering commitment to reauthorizing the Pediatric Priority Review (PPRV) program and to ensuring this bill crossed the finish line. The PPRV program provides critical incentives for rare disease research, and its reauthorization provides stability and confidence for biotech innovators who are leading the way in the discovery of breakthrough treatments.” Source
Sickle Cell Disease Research and Treatment Demonstration Program
For fiscal year 2026, Congress has maintained funding for key Sickle Cell Disease (SCD) programs, including $8.205 million for the Health Resources and Services Administration (HRSA) Sickle Cell Disease Treatment Demonstration Program (SCDTDP). This program aims to improve care quality, increase knowledgeable providers, and transition pediatric patients to adult care. Additionally, $7 million was allocated for newborn screening follow-up and $6 million for CDC data collection
Dr. Lorna Breen Act was the first federal law dedicated to preventing suicide, reducing occupational burnout, and improving mental health support for clinicians. Since enactment, the law has improved access to mental and behavioral health support, encouraged hospitals and health systems to engage with clinicians on well-being initiatives, and helped state licensure boards revise outdated policies that discouraged healthcare professionals from seeking mental health services.
Teaching Health Center Graduate Medical Education (THCGME) Program
Reauthorized through FY2029, the THCGME program supports community-based primary care residency programs to train primary care physician and dental residents in underserved and rural settings.
Lifespan Respite Care Program
Reauthorized for 5 years, the Lifespan Respite Care Program, enacted by Congress in 2006 under Title XXIX of the Public Health Service Act (42 U.S.C 201) and previously reauthorized in 2020, empowers coordinated state systems to provide accessible, community-based respite care services. Respite supports family caregivers of children and adults across all age groups, disabilities, and chronic conditions. As an essential component of home, and community-based long-term services, respite services can contribute to healthier families and the health and well-being of caregivers and care recipients.
PBM Reform
Source: (Google 2026) Gemini (February 4, 2026) Query: “What PBM reforms are in H.R. 7148?”
“This funding package also takes important first steps to rein in Pharmacy Benefit Managers (PBMs). For too long, these middlemen have driven up costs for patients, pocketing savings for themselves rather than passing them on. We look forward to continuing to work with Congress and the Administration to realize a 21st-century vision for healthcare access and affordability for American families. It is time to simplify our health care system, cut out the middlemen, and reduce out-of-pocket costs for patients.” — John F. Crowley Source
Medicare Part D Reforms
- Delinking Compensation: PBMs are prohibited from receiving compensation tied to a drug’s list price. Instead, they may only receive “bona fide service fees,” which must be a flat dollar amount consistent with fair market value.
- Rebate Pass-Through: PBMs must pass through 100% of all rebates, discounts, and price concessions negotiated with manufacturers directly to the Medicare Part D plan sponsors.
- CMS Oversight & Standards: The Centers for Medicare & Medicaid Services (CMS) is now authorized to define and enforce “reasonable and relevant” contract terms for pharmacy reimbursement and participation.
- Appeals Process: The bill establishes a formal appeals process for pharmacies to challenge contract terms that fail to meet these new federal standards.
- Enforcement Penalties: CMS received $188 million in funding to enforce these rules and can now impose civil monetary penalties on non-compliant PBMs.
Commercial & Employer-Sponsored Plan Reforms
- 100% Pass-Through Mandate: For ERISA-governed group health plans, PBMs must pass through 100% of all rebates and remuneration to the plan sponsor. Failure to do so can trigger “prohibited transaction” penalties under ERISA.
- Expanded Disclosure Rules: PBMs are now classified as “covered service providers” under ERISA, requiring them to disclose all direct and indirect compensation to plan sponsors before a contract is signed or renewed.
Transparency & Reporting Requirements
- Annual Reporting: PBMs must provide detailed annual reports to plan sponsors and HHS regarding drug spending, net prices, total rebates collected, and any conflicts of interest.
- Affiliate Transparency: Reports must explicitly identify PBM-affiliated pharmacies and explain any plan designs that encourage or require patients to use those affiliates.
- Audit Rights: Plan sponsors are granted the right to audit their PBMs at least once per year to ensure compliance with financial and reporting obligations.
Medicaid Reform
- Banning Spread Pricing: The bill bans “spread pricing” in Medicaid, moving instead to a transparent pass-through model where the pharmacy is reimbursed based on actual drug ingredient costs plus a professional dispensing fee
Statement by Pharmaceutical Research and Manufacturers of America President and CEO Stephen J. Ubl
“We applaud the broad, bipartisan coalition of lawmakers who came together to pass meaningful PBM reform. These reforms are a win for patients, pharmacists, providers and employers who have urged Washington to hold PBMs accountable. For too long, PBMs have profited from medicines with little transparency or accountability. That starts to change today.
“By cracking down on PBM profit schemes and delivering transparency across the supply chain, these important reforms will generate savings for the health care system and lower costs for patients. As PBMs continue to evolve their business model, policymakers should explore additional reforms to address the harmful consequences of growing consolidation among PBMs and insurers who are increasingly denying care to patients.” Source