The Great Healthcare Plan: Impacts on Pharmacy Benefit Plans

Article originally posted by our RelationRX partner, Truveris:

The White House recently outlined “The Great Healthcare Plan,” a policy framework that calls on Congress to act on several ideas: lowering prescription drug prices, reducing premiums, increasing transparency, and ending insurer/PBM “kickbacks.”

At this stage, the release is primarily a high-level directive, not legislation, and as released it will likely have no immediate effects without accompanying draft bills or operational details.

Proposed Policy Changes in The Great Healthcare Plan

Directing funds to individuals rather than insurers

The administration proposes sending dollars directly to consumers, potentially via Health Savings Accounts (HSAs), to buy coverage, instead of routing enhanced ACA subsidies through carriers. Mechanics and eligibility are not specified and would likely require congressional action.

Drug pricing provisions

The plan aims to codify Most Favored Nation (MFN) style pricing agreements and expand over-the-counter (OTC) access for certain medicines. MFN – style pricing and OTC expansion could potentially reshape list-net dynamics and utilization if the Plan’s proposals go into effect.

Transparency and accountability requirements

Provisions would standardize “plain English” plan information, require public disclosure of medical loss ratios, denial rates, and wait times, and reinforce price transparency rules previously advanced by federal agencies.

Ending PBM/insurer “kickbacks”

The plan pledges to end “kickbacks” but does not define the term or outline a proposed regulatory path at this time. Further detail should be expected, including the outcomes of multiple other legislative efforts already underway to address PBM business models and add transparency to the system.

Bottom line: At this point, The Great Healthcare Plan is primarily a policy signal, not an immediate policy change. Without bill text, Congressional Budget Office (CBO) scoring, or committee movement, employer impacts are limited and uncertain in the near term.

What Employers Can Do Now

• Engage PBMs and benefits consultants with targeted questions: Ask how they are planning for Direct-to-Consumer (DTC) funding models, drug pricing shifts tied to MFN proposals, potential formulary adjustments that might preempt or respond to federal action, and additional transparency mandates.
• Review relevant areas of your pharmacy benefits contract: Identify where legislative changes like subsidies directed to individuals, transparency expansions, or PBM rules might intersect with your current plan structure, especially in areas like HSA eligibility.
• Continue monitoring news and policy announcements: As we’ve mentioned earlier, The Great Healthcare Plan introduces policy directives but is not accompanied by legislature or operational details that would be needed for implementation.

Truveris will continue monitoring news for updates like the introduction of a new bill in Congress, committee text, Congressional Budget Office (CBO) scoring, or agency rulemaking notices and will share more information when available.

Looking Ahead

At this time, The Great Healthcare Plan provides directional priorities but no enforceable requirements until Congress acts. Employers should prepare and monitor developments closely. Expect additional details or alternative legislative updates to clarify the path forward.

Announced by the Trump administration in January of 2026, The Great Healthcare Plan is a national healthcare policy approach intended to reduce the burden of costs on Americans while introducing potential new strategies to shake up the existing healthcare system.

Does the plan immediately change drug prices for plan members?

Not automatically. The plan seeks to codify MFN-style agreements and expand OTC availability, but pricing effects depend on legislative passage and subsequent rulemaking.

Will premium subsidies be redirected to employees’ HSAs?

The framework suggests directing funds to individuals, potentially via HSAs, but does not specify mechanics or eligibility. Any change would require legislation.

What does “ending PBM and insurer kickbacks” mean?

The announcement does not define the term or outline enforcement mechanisms. Further details are expected, and employers should continue or consider expanding PBM oversight practices in the meantime.

Let’s Connect

To better understand how today’s healthcare landscape and especially changes in pharmacy benefits can impact your overall employee benefits strategy, connect with one of Relation’s experienced employee benefits advisor. The right expert can help you evaluate plan performance, manage rising prescription drug costs, and design a benefits program that supports both your people and your bottom line. A proactive review today can lead to smarter decisions, stronger coverage, and long-term cost stability for your organization.

Truveris is a pharmacy cost containment company dedicated to reducing pharmacy costs and driving transparency for employers and benefit consultants. Our proprietary, data-driven technology and deep industry expertise empower smarter pharmacy benefit decisions through contract optimization and PBM oversight. Independent and unbiased, Truveris delivers measurable savings and accountability across every pharmacy program.