The Service Line

Reimbursement: Congress delinked Part D rebates, the FTC delinked commercial insulin margins, and now the Department of Labor wants proof it actually happened

The Consolidated Appropriations Act (CAA) of 2026, signed February 3, 2026, bars pharmacy benefit managers from earning any Part D compensation tied to a drug’s price and requires 100 percent rebate pass-through to plan sponsors, replacing rebate-based pay with a flat “bona fide service fee” that PDP and MA-PD sponsors must enforce starting with the 2028 plan year. The Department of Labor’s companion proposed rule, published January 30, 2026, goes further for self-funded ERISA plans, requiring PBMs to produce claim-level, machine-readable evidence of the gap between what the plan paid and what the pharmacy was reimbursed, not just report the totals; its comment period drew 564 submissions and closed April 15, with a final rule still pending. Layer on the Federal Trade Commission’s February 4 settlement with Express Scripts, already in force, which bars favoring high-list-price drugs on standard formularies and is projected to save patients up to $7 billion in insulin costs over a decade. Three federal actions, three different effective clocks, and an operator’s actual exposure depends on which one governs a given book of business. Confidence: High on what each mandate requires; Medium on final DOL rule timing. Sources: Department of Labor fact sheet on the proposed PBM fee disclosure rule and FTC press release on the Express Scripts settlement, supplemented by PYMNTS.

Enforcement: CVS’s institutional pharmacy unit settles a $440 million fraud case that started as a $950 million jury verdict

CVS Health agreed to a $440 million settlement resolving a decade-old False Claims Act case against Omnicare, its long-term care pharmacy subsidiary, after an April 2025 jury found Omnicare submitted more than 3.3 million fraudulent claims for prescriptions dispensed to nursing home residents without valid orders between 2010 and 2018, a verdict a judge later set at nearly $950 million in damages and penalties. CVS will pay the Justice Department $130 million within two weeks of final approval and the remaining $310 million by March 15, 2028; the deal is contingent on Omnicare’s Chapter 11 sale to GenieRx Holdings and requires bankruptcy court sign-off at an August 12, 2026 hearing. It is the same fact pattern OIG’s Work Plan keeps finding across long-term care and specialty dispensing nationally: claims submitted ahead of, or without, a valid prescription. Confidence: High on the settlement terms; Medium on final court approval given the pending hearing. Sources: Healthcare Dive, supplemented by Modern Healthcare.

Who’s Buying: Private equity keeps buying the picks-and-shovels layer of specialty pharmacy, not just the pharmacies

An affiliate of Peak Rock Capital completed its acquisition of Asembia LLC on July 2, 2026, taking control of the specialty-pharmacy industry’s dominant technology and services layer, patient support hubs, specialty distribution, data services, pharmacy software, and group purchasing, plus the industry’s largest annual conference. Terms were not disclosed, though Peak Rock’s typical check size runs $50 million to $1.5 billion, and the firm says it plans further “complementary acquisitions.” The deal lands the same month Warburg Pincus, partnered with the Abu Dhabi Investment Authority, is finalizing a transaction exceeding $7 billion for PANTHERx Rare, the largest independent rare-disease specialty pharmacy, and roughly a year after Cigna’s Evernorth committed $100 million through 2028 to an AI-powered specialty pharmacy program. Operators evaluating specialty pharmacy partners should watch the ownership behind the software and distribution layer, not just the dispensing pharmacy, since that is where the deal money is landing. Confidence: High on the Asembia close; Medium on final PANTHERx deal terms, which had not closed at the time of the underlying reporting. Sources: PR Newswire, Peak Rock Capital acquisition announcement, supplemented by Forbes.

Clinical Policy: FDA’s window to permanently bar bulk GLP-1 compounding closes July 30, and Arkansas’s PBM ownership ban is still alive on appeal

The FDA’s proposal to exclude semaglutide, tirzepatide, and liraglutide from the section 503B Bulks List, published in the Federal Register May 1, 2026, would permanently foreclose large-scale outsourcing facilities from compounding those GLP-1s outside a declared shortage. The comment period, already extended once, closes July 30, 2026, twelve days from this issue; combined with both drugs’ resolved shortage status, finalizing the rule would close the two legal pathways compounders and the telehealth platforms selling their products have leaned on since 2023. Separately, Arkansas Attorney General Tim Griffin is appealing the July 2025 federal injunction that blocked Act 624, the law banning PBMs from owning in-state pharmacies, after a judge found it likely violates the Commerce Clause and conflicts with TRICARE contracting. The case remains the structural-separation test that lawmakers in Vermont, Texas, and New York are watching before writing their own versions. Confidence: High on the FDA comment deadline; Medium on the Arkansas appeal timeline. Sources: Federal Register, proposed 503B Bulks List exclusion and Healthcare Dive on the Arkansas injunction.

The Operator Metric: 60 percent, and rising

Specialty drugs, GLP-1s foremost among them, now account for 60 percent or more of total drug spending at many employer health plans, according to benefits consultants cited in July 2026 reporting on the specialty-pharmacy buyout wave, a share that has climbed well past the small-molecule maintenance drugs the system was built to manage. That single trend line is why Peak Rock paid up for Asembia’s specialty infrastructure, why Cigna’s Evernorth is putting $100 million behind an AI specialty program, and why Warburg Pincus is paying more than $7 billion for a rare-disease specialty pharmacy. Whoever controls specialty formulary design, prior authorization, and site-of-care now controls the majority of the drug budget. If your plan’s specialty share is not already above half, find out whether that reflects your population or your PBM’s steering. Confidence: Medium, this is a directionally consistent figure drawn from consultant conversations rather than an independently audited survey. Source: Forbes.