Washington, D.C. — Insurance Watchdog Coalition (IWC) today sent a letter to leaders of the Senate Health, Education, Labor, and Pensions (HELP) Committee calling on lawmakers to broaden their approach to lowering prescription drug costs by addressing the role of health insurance companies in determining what patients pay.

In the letter to Chairman Bill Cassidy, Ranking Member Bernie Sanders, and members of the Committee, IWC commended their ongoing efforts to reduce drug prices but warns that current policy discussions risk overlooking a central driver of patient costs: insurance design and insurer-controlled pricing mechanisms. New polling released from IWC reveals that voters nationwide – and across the political spectrum – overwhelming support insurance reform as the top priority in improving health care.

“While policymakers have taken important steps to address drug pricing, insurance barriers remain the greatest threat to affordability,” said Mark Merritt, executive director of IWC. “For most patients, out-of-pocket costs are set by insurers – not drug manufacturers – and often bear little relationship to list prices.”

The letter outlines how rising premiums, restrictive formularies, and high out-of-pocket costs continue to limit access to medications, even as policymakers pursue pharmaceutical pricing reforms.

IWC’s letter also highlights structural concerns within the insurance system, particularly the growing vertical integration of insurers with pharmacy benefit managers (PBMs), specialty pharmacies, and provider groups. According to the Coalition, these arrangements create conflicts of interest and enable insurers to influence pricing and access decisions across the prescription drug supply chain.

The letter raises specific concerns about the use of affiliated PBM group purchasing organizations (PBM GPOs), including those domiciled offshore, which can be used to retain manufacturer rebates and reduce transparency into whether savings are passed on to patients.

Recent federal enforcement activity underscores these risks. The Federal Trade Commission has reached a settlement with Express Scripts, a subsidiary of Cigna, related to aspects of its rebate and PBM GPO arrangements. Similar structures remain in place across other major PBMs affiliated with large insurers.

In addition, IWC points to federal policy opportunities to reduce waste and improve affordability. It highlights the No Unreasonable Payments, Coding, or Diagnoses for the Elderly (No UPCODE) Act as one example, noting that eliminating an estimated $124 billion in excess payments could help lower out-of-pocket costs for Medicare beneficiaries.

“Patients are facing increasing barriers to care – from prior authorization delays to coverage denials – while opaque pricing structures make it harder to understand where healthcare dollars go,” Merritt said. “We urge the Committee to take a comprehensive approach that includes meaningful insurance reform.”

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Insurance Watchdog Coalition’s mission is to educate legislators, regulators, key opinion leaders, the media and the American people about the harmful impacts of vertically integrated insurance monopolies, especially in our healthcare system, which in turn will help create more competition in the marketplace, lower healthcare costs, and ensure that healthcare savings go to patients, not big insurers.

WASHINGTON, DC – A new national survey out today reveals a striking and unified sentiment among American voters: there is strong, bipartisan support to rein in health insurance companies by breaking up existing monopolies and eliminating rampant waste, fraud and abuse.

OnMessage Public Strategies, on behalf of Insurance Watchdog Coalition, conducted the poll of 1,000 likely voters nationwide. The survey found that across the political spectrum, voters are overwhelmingly aligned in their concerns about the health care system. Large majorities place the blame primarily on health insurance companies, support breaking up large insurers and indicate they are more likely to support candidates for public office who champion health insurance reform.

Health Insurance Industry Faces Deep Public Disapproval

Public sentiment toward health insurance companies has deteriorated to strikingly low levels. Just 17% of voters view insurers favorably, while 78% hold unfavorable views, including 47% who say their opinion is “very unfavorable.”

When asked which industry Congress should prioritize, health insurance companies are the overwhelming answer:

• 60% say Congress should focus on health insurance companies — the overwhelming top choice
• 18% pharmaceutical companies
• 8% hospital systems
• 6% pharmacy benefit managers (PBMs)

This concern spans party affiliation, with Democrats, Republicans, and Independents all identifying health insurers as the top priority.

Strong Support for Cutting Waste, Fraud, and Abuse

The survey finds significant backing for President Trump’s efforts to reduce waste, fraud, and abuse in government health care programs, with 81% of likely voters say they would be more likely to vote for a candidate focused on eliminating inefficiencies and holding both government programs and insurance companies accountable.

Broad, Bipartisan Support for Structural Reform

Voters are not only dissatisfied – they support structural change:

• 70% say they are more likely to support a candidate who favors breaking up large health insurance companies
• 90% agree insurers have too much control and should be broken up, including 74% who strongly agree

Key Messages Drive Support Even Higher

Support for reform intensifies when voters are presented with specific information about industry practices. Among the most compelling findings:

• 89% support action after learning insurers have created monopolies in local markets
• 88% support action after hearing about vertical integration across PBMs, pharmacies, and other services
• 87% support action after learning insurers are acquiring large numbers of physician practices
• 87% support action after hearing that a handful of companies control more than half the market

These results highlight strong voter reactions to concerns about consolidation, conflicts of interest and market dominance.

Clear Political Implications

The survey underscores significant electoral consequences tied to this issue:

• 84% say they would support a candidate who takes on insurance companies to lower costs, including 81% of Independents and 80% of undecided voters (44% strongly agree)
• 86% are less likely to vote for a candidate funded by big insurance companies (67% much less likely)

Overall, voters increasingly view health insurance companies as central to rising costs and systemic inefficiencies, and they are calling for meaningful reform. As health care costs continue to climb, this issue is a key factor in voter decision-making, with clear incentives for candidates willing to seek reforms in the industry.

Read the full survey memo.

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Insurance Watchdog Coalition’s mission is to educate legislators, regulators, key opinion leaders, the media and the American people about the harmful impacts of vertically integrated insurance monopolies, especially in our healthcare system, which in turn will help create more competition in the marketplace, lower healthcare costs, and ensure that healthcare savings go to patients, not big insurers.

Congress Made Important Strides on PBM Reform, But More Must Be Done

WASHINGTON, DC – Insurance Watchdog Coalition (IWC) today issued a statement in firm support of the bipartisan inquiry led by the House Committees on Oversight and Reform into the predatory practices of Pharmacy Benefit Managers (PBMs).

We encourage Chairman James Comer (R-KY) of House Committee on Oversight and Government Reform and House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies Chairman Robert Aderholt (R-AL) to keep pursuing insurance and PBM reforms that reduce prescription drug costs for patients.

While the recently signed Consolidated Appropriations Act, 2026 (passed February 3, 2026) represents a significant step in the right direction toward reforming PBM “black box” accounting, many PBM profit schemes remain intact.  IWC encourages Congress to take swift action to address these practices and deliver real savings for American employers, taxpayers and healthcare programs.

Insurers and PBMs continue to utilize many predatory tactics identified in the Committee’s 2024 investigation into PBMs such as:

• Prior Authorization Abuse: Administrative hurdles used to override doctors and steer patients to profitable drugs.
• “Fail-First” Mandates: Forcing patients onto ineffective drugs before accessing prescribed, life-saving therapies.
• The Medicaid Gap: The new law fails to ban “spread pricing” in Medicaid, leaving low-income patients vulnerable to hidden PBM markups.
• Patient Steering: Mandating use of PBM-owned mail-order pharmacies, undermining local community access.

IWC hopes that Congress will prioritize addressing these harmful practices that decrease healthcare access and affordability.

Mark Merritt, executive director of the IWC, stated: “We are encouraged by the momentum that exists in Congress to address insurer and PBM predatory practices and are thankful for the Trump Administration’s commitment to addressing the rampant fraud and abuse within the American insurance marketplace. We need reforms now so patients can get their medications without jumping through hoops or paying sky-high insurance co-pays at the pharmacy counter.”

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Insurance Watchdog Coalition’s mission is to educate legislators, regulators, key opinion leaders, the media and the American people about the harmful impacts of vertically integrated insurance monopolies, especially in our healthcare system, which in turn will help create more competition in the marketplace, lower healthcare costs, and ensure that healthcare savings go to patients, not big insurers.

WASHINGTON, DC – Insurance Watchdog Coalition (IWC)commends the U.S. House Energy and Commerce Committee for focusing its hearing today on fraud and abuse in Medicare and Medicaid—areas where the scale of the problem has grown significantly and demands urgent scrutiny.

“Large insurance companies have turned Medicare and Medicaid into giant ATMs—and taxpayers are footing the bill,” said Mark Merritt, executive director of IWC.

As Congress examines fraud in federal health programs, IWC warns that the largest drivers of waste are no longer isolated actors, but large, vertically integrated insurance companies and the intermediaries they control.

Three Major Drivers of Waste and Abuse

PBM Practices Inflating Drug Costs

Vertically integrated pharmacy benefit managers (PBMs), often owned by large insurers, now control most of the prescription drug market and play a key role in determining drug pricing and access.

Key practices driving higher federal spending include:

• Spread pricing, where PBMs charge payers more than they reimburse pharmacies
• Rebate-driven formularies, favoring higher-priced drugs with larger rebates
• Steering to PBM-owned pharmacies, particularly for high-cost specialty drugs

These arrangements allow insurers and their affiliated PBMs to extract additional revenue

from taxpayer-funded programs, while obscuring the true cost of prescription drugs.

Medicare Advantage Upcoding and DOJ Litigation

Medicare Advantage has become one of the largest and fastest-growing components of federal healthcare spending. Its payment system creates strong incentives to maximize reported diagnoses—and therefore federal payments.

These practices are now at the center of federal fraud litigation. In United States ex rel. Poehling v. UnitedHealth Group, the U.S. Department of Justice alleges that UnitedHealth Group identified unsupported diagnoses through internal reviews but failed to delete them before submitting data to Medicare, inflating payments.

Beyond individual cases, the broader fiscal impact is substantial. Analysis from the Committee for a Responsible Federal Budget estimates that current Medicare Advantage payment policies could result in approximately $1.2 trillion in excess federal spending over the next decade.

This is not incidental overpayment—it reflects a system that rewards higher coding intensity and drives higher federal spending, with costs passed on to seniors through increased Medicare Part B premiums.

“This isn’t incidental overpayment—it’s a business model,” Merritt said.

Taken together, these practices reflect a system where the largest financial gains come not from delivering care, but from maximizing payments.

Offshore GPOs: “Ghost PBM Organizations”

PBM-controlled Group Purchasing Organizations (GPOs) operating offshore have emerged as a new mechanism for collecting administrative fees tied to drug rebates.

These entities:

• Operate under a 1987 Anti-Kickback Statute safe harbor never designed for this purpose
• Collect fees tied directly to rebate volume and drug prices
• In some cases operate outside the United States, increasing opacity and limiting oversight

These structures allow PBMs to capture additional revenue tied to higher drug prices, embedding incentives that drive up costs in taxpayer-funded programs.

These entities exist not to lower prices, but to collect fees tied to higher ones—embedding incentives that work directly against taxpayers.

Call for Congressional Action

IWC urges Congress to align oversight with how the healthcare system actually operates today.

This includes:

• Full transparency into PBM pricing and rebate flows
• Stronger auditing and enforcement of Medicare Advantage risk-adjustment practices
• Reform of the GPO safe harbor as applied to PBM-controlled entities

Until Congress addresses these structures, the largest drivers of Medicare and Medicaid waste will remain untouched.

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The Insurance Watchdog Coalition’s mission is to educate legislators, regulators, key opinion leaders, the media and the American people about the harmful impacts of vertically integrated insurance monopolies, especially in our healthcare system, which in turn will help create more competition in the marketplace, lower healthcare costs, and ensure that healthcare savings go to patients, not big insurers.

WASHINGTON, D.C. — New polling conducted by OnMessage Public Strategies on behalf of The Insurance Watchdog Coalition, a nonprofit organization that educates the public about the harmful impacts of vertically integrated health insurance monopolies, finds that voters in two key Senate battleground states see health insurance as a rising affordability issue and are likely to play a significant role in shaping voter attitudes in this fall’s elections. 

The surveys of likely voters in Maine and Ohio also show competitive Senate races in both states. 

The polls were conducted March 3–8, 2026 among 600 likely voters in each state via live caller interviews, with a margin of error of ±4.0%.

Toss-Up Races

In Maine, the ranked-choice ballot shows a statistical tie:

·       Susan Collins – 42% / Janet Mills – 42%, with 16% undecided or not ranking either candidate

·       Graham Platner – 44% / Susan Collins – 42%, with 14% undecided or not ranking either candidate

In Ohio, the Senate race is similarly close:

·       Sherrod Brown – 47% / Jon Husted – 45% / 8% undecided

Voters Say Insurance Costs Drive Health Care Affordability Concerns

·      When voters are asked specifically about their biggest health care cost pain points, their concerns overwhelmingly center on insurance-related costs and practices. Voters (73% in Maine, 72% in Ohio) say health insurance prices, deductibles, and coverage denials are their biggest personal pain points.

·      71% of Maine voters and 78% Ohio voters agree that “since President Trump has already negotiated deals with drug manufacturers on prescription drug prices, we should turn now to focusing on deals and policies that lower the price of health insurance premiums, address insurance denials, and reduce other barriers to care.”

·      Policy proposals focused on increasing transparency in health insurance pricing, reducing health insurance denial rates, and preventing middlemen from marking up prescription drugs find nearly 90% support from voters.

Voters Have Shifted Focus More Directly to Health Insurance Companies

Turning to the issue of health care, voters have expressed increasing concern about rising health insurance costs, and addressing those costs has become a top priority when they think about health care affordability. Thinking about specific pain points in health care, voters point most often to cost issues related to health insurance (73% total in Maine, 72% total in Ohio).

·      Health insurance prices (32% in Maine / 29% in Ohio)

·      Deductible and copays (24% in Maine / 26% in Ohio).

·      Denial of health insurance coverage (18% in Maine / 16% in Ohio)

·      Prescription drug prices (7% in Maine / 9% in Ohio).

·      Compared to other players in the health care system, voters overwhelmingly believe policymakers should focus on health insurance companies when addressing the problems in health care that impact them most.

o   In Maine: 39% health insurance companies / 14% hospital systems / 12% pharmaceutical companies / 6% PBMs

o   In Ohio: 37% health insurance companies / 14% pharmaceutical companies / 12% hospital systems / 6% PBMs

o   Though hospital systems, pharmaceutical companies, and PBMs are still priorities, health insurance companies are the top concern for voters across the political spectrum by nearly a 3:1 margin. 

·      When asked which policy would be most helpful in lowering their health care costs, the largest share of voters choose cracking down on health insurance companies.

o   Cracking down on health insurance companies for price gouging, raising premiums, and denying coverage (40% in Maine / 37% in Ohio)

o   Requiring prescription drugs to be sold to Americans at the same prices as Europeans (16% in Maine / 14% in Ohio).

o   Increasing transparency and eliminating hidden fees (11% in Maine / 10% in Ohio)

o   Cutting out the middlemen who markup prescription drug costs (12% in Maine / 12% in Ohio).

o   Cracking down on health insurance companies for pricing gouging, raising premiums, and denying coverage was the top choice for voters of either party and undecided voters.

Voters Strongly Holding Pharmacy Benefit Managers Accountable, Requiring Insurance Companies To Cover Certain Treatments and Transparency Around Coverage Denials 

·      91% in Maine and 90% in Ohio support more transparency for health insurance companies so they can’t use secret rules or computers programs to decide who gets care and when.

·      91% in Maine and 92% in Ohio support requiring health insurance companies to report how often they deny coverage for medicines.

·      89% in Maine and 90% in Ohio support requiring health insurance middlemen, known as pharmacy benefit managers, to pass the savings they negotiate directly onto patients and ban them from marking up the costs of drugs.

·      89% in Maine and 90% in Ohio support requiring health insurance to cover the treatments and procedures your doctor prescribes without denials or surprise bills.

Voters Favor Candidates Who Crackdown on Insurance Premiums Over Drug Price Setting

·      In Maine, 58% of Independents and 55% of undecided voters prefer the candidate focused on lowering health insurance premiums over the candidate focused on the government setting drug prices.

·      In Ohio, 60% of Independents and 57% of undecided voters prefer the candidate focused on lowering health insurance premiums over the candidate focused on the government setting drug prices.

About the Insurance Watchdog Coalition

The Insurance Watchdog Coalition is a nonprofit organization that educates the public about the harmful impacts of vertically integrated health insurance monopolies and advocates for policies that increase transparency, lower costs, and improve access to care for patients.

Read the full survey memo.

WASHINGTON, DC – Insurance Watchdog Coalition (IWC) today thanked Energy and Commerce Committee members for continuing their efforts to confront rising healthcare costs for American taxpayers and urged Congress to build on recent momentum by advancing additional policies that crack down on the self-serving, profit-driven practices of health insurance corporations and their affiliated pharmacy benefit managers (PBMs). For too long, these vertically integrated giants have prioritized revenue and market control over patients and payers—using their position to extract profits, steer care and drive up costs across the healthcare system. 

In a letter submitted for the record to the House Energy and Commerce Committee, IWC highlighted structural payment and pricing practices in the drug supply chain that increase costs for taxpayers, American employers and government healthcare programs alike.

These include:

• Vertical integration and self-dealing among insurers and their subsidiaries
• Waste, fraud, and abuse mechanisms such as spread pricing and improper payments
• Upcoding to increase federal payments by making Medicare patients look sicker than they are
• Offshoring GPO rebating functions that erode oversight and accountability
• Percentage-based fee models that enable intermediaries to profit from higher prices
• Rebate and shell-game arrangements that obscure true net costs

In just one federal program—Medicare Advantage—overpayments to insurers are projected to total approximately $1.2 trillion over the next decade.

While recent passage of the Consolidated Appropriations Act of 2026 is a positive step, insurers are already adjusting business practices to preserve revenue streams and offset new reforms.

According to a recent IWC poll, a strong majority of Americans (63%) want Congress to address insurance reform in this year’s health debate. Further, the poll showed that more than 90% agree with reforms that would increase transparency in costs and claim denials, prevent insurance companies from marking up prescription drug costs and give more control to patients and their doctors. 

“The prescription drug supply chain is supposed to make medicines accessible and affordable — not create barriers and drive prices higher,” said Mark Merritt, Executive Director of the Insurance Watchdog Coalition. “Congress must dismantle practices that allow corporate insurers and their PBMs to inflate costs without improving affordability or access to patient care.”

IWC also applauded initiatives such as TrumpRx and Mark Cuban’s Cost Plus Drug Company, which demonstrate that removing unnecessary intermediaries can deliver measurable savings directly to consumers.

February 5, 2026

Insurance Watchdog Coalition Congratulates Trump Administration on Landmark

FTC Settlement with Express Scripts

Curbing PBM Practices that Increase Prescription Drug Costs

WASHINGTON, DC – Insurance Watchdog Coalition (IWC) today congratulated President Trump and the Federal Trade Commission for securing a landmark settlement with Express Scripts, one of America’s largest pharmacy benefit managers (PBMs). It resolves the FTC’s lawsuit alleging anticompetitive and unfair rebating practices that artificially inflated insulin prices and reduced access to lower-cost options.

Starting in 2028, the settlement will change the following at Express Scripts:

• Decouple PBM compensation from list prices of prescription drugs;
• End the practice of preferring high-list-price drugs when lower-cost equivalents exist;
• Require point-of-sale rebates to be passed directly to patients;
• Provide covered access to direct-to-consumer pricing via TrumpRx, with patient payments counting toward deductibles and out-of-pocket maximums;
• Shift to cost-plus reimbursement for retail pharmacies;
• Increase transparency in drug costs and spending;
• Move its Group Purchasing Organization (GPO) from Switzerland to the United States.
• If the other two large PBMs – CVS and Optum – also settle, it will fundamentally curb industry practices that enrich the corporate insurers owning the PBMs.

As the FTC oversees implementation of these changes, it should be vigilant to ensure insurers don’t continue abusive PBM business practices under the umbrella of the GPO, which performs many of the same functions.

“This will curb PBM shell games that cost patients, employers and taxpayers billions. Now Congress must address broader insurance practices that raise prescription drug costs—like excessive prior authorizations, unfair denials, and high out-of-pocket costs. These make insured patients choose between paying full price and forgoing the medications they need,” said Mark Merritt, executive director of IWC.

The settlement comes on the heels of the Consolidated Appropriations Act, which de-links PBM profits from drug list prices in Medicare Part D, requires 100% pass-through of rebates and opens Part D networks to more community pharmacies – steps we strongly support.