This bipartisan healthcare bill aims to break up 'big medicine.' Here's how it could affect your practice

A bipartisan pairing in the Senate is taking aim at consolidation across the healthcare industry. In February 2026, Elizabeth Warren (D-Mass.) and Josh Hawley (R-Mo.) introduced the “Break Up Big Medicine Act,” legislation designed to curb the vertical integration that has increasingly defined the US healthcare system. ^[]

The proposal targets the growing trend of insurers, pharmacy benefit managers (PBMs), and provider organizations operating under the same corporate roof—a structure critics say raises prices and squeezes independent clinicians. ^[]

For physicians watching consolidation reshape the healthcare landscape, the bill raises an important question: What would it actually change—and could it alter the balance of power between large healthcare conglomerates and independent clinics?

The problem the bill targets: vertical integration

Over the past decade, major healthcare companies have increasingly combined insurance, pharmacy benefit management, and clinical services within a single corporate structure. ^[]

“In recent years, health insurers have morphed into Wall Street-controlled bank-like institutions that bear little resemblance to the nonprofit organizations most of them were just a few years ago. In fact, many of the country’s biggest health insurers are essentially financial institutions that also own a health insurance company,” wrote Wendell Potter, former vice president of corporate communications for Cigna. ^[]

The Warren-Hawley proposal argues that this “vertical integration” creates conflicts of interest and reduces competition. ^[] According to the bill’s sponsors, the structure allows companies to steer patients toward their own providers and leverage market power to increase prices.

Recent congressional hearings questioning major insurers and PBMs helped set the stage for the legislation, as lawmakers examined how consolidation may affect drug pricing and access to care. ^[]

What the ‘Break Up Big Medicine Act’ would do

At its core, the bill would force structural separation between different sectors of the healthcare industry.

Key provisions of the bill include:

1. Banning common ownership across certain healthcare sectors: Parent companies could not simultaneously own a health insurer or PBM and a medical provider organization (or management services organization). ^[]

2. Restricting supply-chain consolidation: Companies that own prescription drug or medical device wholesalers would also be prohibited from owning medical providers or management serivces organizations. ^[]

3. Eliminating financial conflicts within vertically integrated firms: The aim is to prevent scenarios where one corporate entity controls multiple steps in the healthcare transaction—from coverage decisions to prescribing, dispensing, and care delivery. ^[]

In practice, the bill could force large healthcare conglomerates to divest certain subsidiaries or spin off business units, similar to structural separation policies historically used in industries like banking. ^[]

As of today, the legislation has been introduced but has not yet been voted on. While still in early stages of the legislative pipeline, its introduction reflects growing bipartisan interest in antitrust action against healthcare consolidation.

What it could mean for your clinic

If enacted—even in a modified form—the proposal could reshape several parts of the healthcare ecosystem that physicians interact with daily.

1. Potentially more negotiating power for independent practices

Large insurers and PBMs currently have significant leverage in contract negotiations. Structural separation could reduce the influence of vertically integrated companies, potentially giving independent physician groups more bargaining power.

2. Changes in referral and network dynamics

If insurers can no longer own provider groups, patient steering toward corporate-owned clinics could decline, potentially increasing competition for referrals.

3. Shifts in payer-provider relationships

Healthcare conglomerates that combine insurance, pharmacy services, and clinical delivery might be forced to restructure contracts and networks, which could affect reimbursement models and administrative processes.

4. Possible impact on drug pricing and formularies

Proponents say separating PBMs and insurers from provider ownership could reduce conflicts in drug pricing decisions, though critics warn the disruption could introduce new administrative complexities.

What it could mean for patients 

For patients, proponents argue the bill could:

• Increase competition among providers

• Reduce drug and insurance costs

• Improve transparency in treatment and coverage decisions

"In general, I support this bill to break up big medicine, decrease costs for our patients, reduce paperwork burden for our pharmacies and our clinicians, increasing incentives and support for our independent clinicians as well," Bright Zhou, MD, MS, a family medicine professor at Stanford, shares on TikTok.

The bottom line

Whether or not this specific bill becomes law, its introduction signals a growing bipartisan concern about consolidation in healthcare markets. Policymakers across the political spectrum are increasingly scrutinizing how vertically integrated healthcare giants influence costs, access, and competition.

For clinicians, that means the regulatory environment around insurer-provider relationships, PBMs, and corporate ownership of medical practices could look very different in the coming years.