Washington Watch: Health Week of February 9, 2026 | House Energy & Commerce Committee | Vol. 1, Issue 1

Weekly Healthcare Policy Briefing — Puerto Rico Focus

This Week at a Glance

Healthcare took center stage this week in Washington. The Energy & Commerce Health Subcommittee convened nine industry leaders to examine why prescription drugs cost so much in this country. The verdict was nearly unanimous: pharmacy benefit managers are a major part of the problem.

Meanwhile, Puerto Rico's healthcare leaders were on Capitol Hill pressing Congress for Medicaid funding extensions, with a private sector delegation coordinated by Maceira Zayas Law meeting with Chairman Brett Guthrie and other key members of the Committee.

On the regulatory front, CMS proposed new rules to lower healthcare costs and expand consumer choice, and HHS's electronic health records exchange network crossed the 500 million records milestone.

On the Hill

Health Subcommittee Hearing: The Prescription Drug Supply Chain

Lowering Health Care Costs for All Americans: An Examination of the Prescription Drug Supply Chain

February 11, 2026 | Rayburn 2123 | Chair: Rep. Morgan Griffith (R-VA)

This was the second hearing in the Committee's series on healthcare affordability. Nine witnesses representing every link in the drug supply chain—manufacturers, generic drugmakers, wholesalers, PBMs, group purchasing organizations, pharmacies, large employers, and academia—testified before the subcommittee.

The Central Conflict: Who Is Driving Up Drug Costs?

The hearing produced a clear fault line. Nearly every witness pointed the finger at pharmacy benefit managers (PBMs) as a primary driver of high drug costs, while PBMs countered that manufacturers' pricing practices are the real problem.

What the witnesses said:

• Drug manufacturers (PhRMA): COO Lori Reilly testified that middlemen—PBMs and insurers—now capture 50 cents of every dollar spent on brand medicines. She argued that PBMs systematically favor high-list-price drugs because they generate larger rebates, rather than steering patients toward more affordable options.
• Biotech innovators (BIO): CEO John Crowley emphasized that 76% of new medicines originate in small startups and framed U.S. pharmaceutical leadership as a national security issue amid competition from China. He proposed a "21st Century Access" roadmap that includes capping out-of-pocket costs and reforming PBM practices.
• Generic drugmakers (AAM): CEO John Murphy highlighted a striking imbalance: generics fill 90% of prescriptions but account for only 12% of total drug spending. He blamed "patent thickets" by brand manufacturers and PBM rebate structures that favor expensive branded drugs over cheaper alternatives.
• PBMs (PCMA): CEO David Marin pushed back, arguing that PBMs save the healthcare system $333 billion annually through negotiated discounts and generic utilization. He warned that legislative proposals to "delink" PBM compensation from drug prices would actually increase premiums for seniors.
• Wholesalers (HDA): CEO Chip Davis framed distributors as the "backbone" of the supply chain, moving 96% of all medicines at very low margins and saving the system $78 billion annually. He urged Congress not to disrupt logistics that are already highly efficient.
• Large employers (ERIC): CEO James Gelfand criticized vertical integration in the healthcare industry, arguing it allows entities to extract profit through exclusionary rebate structures. He supported transparency requirements for all supply chain actors and eliminating barriers to biosimilar adoption.
• Independent pharmacies (NCPA): CEO Douglas Hoey testified that vertical and horizontal consolidation has created "pharmacy deserts" across the country. He described PBM reimbursement practices as predatory and called for legislation requiring "reasonable and relevant" contracts to protect community pharmacies.
• Academic perspective (Washington University): Professor Rachel Sachs argued that the affordability crisis stems from long-lasting high prices on branded products, enabled by government-granted exclusive rights. She recommended strengthening the Medicare Drug Price Negotiation Program and eliminating the statutory distinction for "interchangeable" biosimilars.

What to Watch: The Committee is building a legislative record that points toward PBM reform. Expect legislation targeting transparency in rebate practices, potential "delinking" of PBM compensation from drug list prices, and protections for independent pharmacies. Any reforms that emerge will directly affect drug pricing and formulary decisions for Puerto Rico's Medicare and Medicaid populations.

Puerto Rico in Washington

Congressional Fly-In: Medicaid Funding for Puerto Rico

Puerto Rico's Senate President Thomas Rivera Schatz led a private sector delegation to Capitol Hill this week to press Congress for extensions of the island's Medicaid funding. The visit, coordinated by Maceira Zayas Law, included meetings with various members of the Energy & Commerce Committee. Among the highlights, the delegation met with Committee Chairman Brett Guthrie (R-KY) and delivered a congressional briefing to Rep. Nick Langworthy (R-NY) on the urgency of Puerto Rico's healthcare funding needs.

Without congressional action, Puerto Rico faces significant shortfalls in its Medicaid program, which operates under a capped block grant rather than the open-ended matching formula available to states.

Other Advocacy Activity

Simultaneously, the Puerto Rico Federal Affairs Administration (PRFAA) conducted a separate fly-in focused on community health centers (Centros 330) and held additional meetings with Energy & Commerce Committee members on healthcare funding priorities for the island.

Flu Epidemic Underscores Funding Urgency

The advocacy push comes against the backdrop of a severe influenza epidemic on the island. Puerto Rico has reported more than 42,000 confirmed cases, over 3,000 hospitalizations, and 128 deaths. Nearly 46% of all confirmed cases are children. While case numbers have begun to decline, the epidemic has placed significant strain on the island's healthcare infrastructure and reinforces the case for equitable federal funding.

Agency Watch: CMS & HHS

CMS Proposes Regulations to Lower Healthcare Costs

February 9, 2026

CMS released proposed regulations with several significant provisions:

• Repeal of standardized option plans, providing insurers more flexibility in plan design
• Broader affordable options by permitting low-deductible plans with higher out-of-pocket limits
• Expanded hardship exemptions for marketplace enrollees
• Non-network plan certification: permitting non-network plans to be certified as qualified health plans, contingent on sufficient provider choice
• Fraud prevention measures, including additional income verifications, limits on premium tax credits for eligible noncitizens, requirements that states fund extra mandated benefits, restrictions on certain special enrollment pathways, and tighter tax filing reconciliation rules

TEFCA Crosses 500 Million Records

February 11, 2026

HHS's Trusted Exchange Framework and Common Agreement (TEFCA)—the nationwide infrastructure for electronic health information exchange—has reached nearly 500 million health records exchanged. For context, this number was just 10 million in January 2025. This infrastructure is designed to increase access to health data and lower costs across the system.

Other HHS Activity

• BHA Assessment (Feb. 10): HHS launched an assessment of butylated hydroxyanisole (BHA), a common food preservative suspected of being a carcinogen.
• Dental Amalgam Phase-Out (Feb. 9): The Indian Health Service announced it will end the use of mercury-containing dental amalgam in its facilities by the end of 2027.
• HHS Leadership (Feb. 12): Secretary Kennedy hired Chris Klomp as Chief Counselor of HHS.

Looking Ahead

No Health Subcommittee hearings or markups have been announced for the week of February 16. We will continue monitoring for scheduling announcements.

On Our Radar:

• Continued congressional engagement on Puerto Rico Medicaid funding extensions following this week's fly-in
• Potential legislative action on PBM transparency and reform as the Committee builds on its hearing series
• CMS comment period on the proposed healthcare cost regulations
• Monitoring flu epidemic trajectory and its implications for federal healthcare funding arguments

Need more detail? Maceira Zayas Law offers in-depth regulatory analysis, legislative tracking, and staff training on federal healthcare developments affecting Puerto Rico. For questions about any item in this briefing, or to schedule a consultation on how these developments may affect your organization, contact Ginnell Torres Adrover, Health Law Associate, at gtorres@mzls.com

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About the photo: Puerto Rico's private sector delegation, led by Senate President Thomas Rivera Schatz, during a congressional briefing with Rep. Nick Langworthy (R-NY) on Capitol Hill, February 2026.

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‍© 2026 Maceira Zayas Law. All rights reserved. This briefing is provided for informational purposes only and does not constitute legal advice.

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