Reforms in Health Savings Accounts and Pharmacy Benefit Managers

The U.S. Secretary of Health and Human Services, Robert F. Kennedy Jr., addressed lawmakers on necessary reforms regarding health savings accounts (HSAs) and pharmacy benefit managers (PBMs). During budget hearings with the House Ways & Means Committee and the House Education & Workforce Committee, Kennedy emphasized increased competition to mitigate health care costs and improve patient access.

Kennedy advocated for redirecting subsidies directly to consumers through HSAs or similar mechanisms, a strategy supported by President Donald Trump since late 2025. He contended that this approach would rectify inefficiencies created under the Affordable Care Act, which benefited insurers more than reducing consumer premiums.

In his testimony before the House Education & Workforce Committee, Kennedy backed new federal transparency regulations targeting PBMs, which manage prescription drug benefits for insurers and self-funded employer plans. He criticized existing PBM profit models for inflating drug costs without value addition and highlighted efforts to address these cost drivers.

Kennedy acknowledged positive reforms by companies like Cigna, particularly through their PBM division, Express Scripts. He pointed out that previous compensation models incentivized more expensive drug selections, thus escalating health care expenses.

Recent legislative efforts, such as the Every Dollar Counts Act introduced by Rep. Greg Murphy, R-N.C., aim to ensure out-of-pocket spending on covered drugs counts toward a patient's deductible and out-of-pocket limits, regardless of purchase location. Furthermore, the Lockton 2026 National Benefits Survey highlights that nearly half of self-funded plan sponsors are exploring international drug sourcing—a strategy demanding careful compliance and risk management to avoid potential legal issues.