Bipartisan Spending Package Includes Wins and Cuts for Rheumatology

President Donald J. Trump signed a $1.2 trillion bipartisan federal spending package into law on February 3, 2026, sparking mixed reactions from experts in the field of rheumatology. While the package includes key reforms regarding pharmacy benefit managers (PBMs) and telehealth, it also features cuts to the CDC Arthritis Program.

Key Takeaways

• The latest funding package from Congress includes cuts to the CDC Arthritis Program.
• The package also includes pharmacy benefit manager and telehealth reforms.

PBM Reforms: A “Good Start”

Experts are cautiously optimistic about the PBM reforms included in the spending package. Madelaine Feldman, MD, FACR, vice president of advocacy and government affairs for the Coalition of State Rheumatology Organizations (CSRO), described the reforms as “a good start.”

“As CSRO was one of the early physician voices educating others about PBMs, we are encouraged to witness Congress finally acknowledging the demand for greater transparency, accountability and, hopefully, patient-centered protections in the PBM marketplace,” she said.

Among the key provisions is a mandate that 100% of rebate savings go to patients covered under plans governed by the Employee Retirement and Income Security Act (ERISA), which include employer-sponsored health plans and pension funds. CMS must also define and enforce relevant, reasonable and transparent Part D contract terms for pharmacies, with implementation planned for January 1, 2029, according to a statement from the American Pharmacists Association (Healio).

PBMs will also transition from price-based compensation to service-based payments starting January 1, 2028. The Government Accountability Office and the Medicare Payment Advisory Commission will produce reports evaluating PBM arrangements.

William F. Harvey, MD, MSc, FACR, President of the American College of Rheumatology, applauded Congress for injecting transparency into PBM behavior. “Despite the advances in therapeutics in the last 2 decades, the primary barrier to effective management of rheumatic disease remains access to drugs,” he said. “Their high cost has led to a rise in medical bankruptcies or the perverse choice some patients build to treat their disease or take care of their families.”

Feldman noted that while the reforms are encouraging, the fight is far from over. “PBMs have always been 5 to 10 years ahead of any type of regulation, and there are still enough black boxes in the drug supply chain in which PBMs can hide profits at the expense of patients.” She also highlighted the need to address vertically integrated oligopolies, referencing the bipartisan Break Up the Large Medicine Act currently in the Senate.

Cuts to the CDC Arthritis Program: “Drastic Reductions”

A significant concern within the rheumatology community is the reduction in funding for the CDC Arthritis Program, from $11 million in 2024 to $2 million in the new spending package. Harvey described these cuts as detrimental to the nearly 60 million Americans living with doctor-diagnosed arthritis.

“The loss of funding counteracts efforts to support the health and wellbeing of people with arthritis,” Harvey said. “It can lead to loss of critical data collection. We will see drastic reductions in scientific innovation to identify essential treatments and eventually a cure.” He also expressed concern about the impact on state and local governments’ ability to manage public health risks and the elimination of community-based programs, particularly in rural areas.

Telehealth Extension: A “Temporary” Win

The spending package extends Medicare telehealth payment flexibilities through the end of 2027, including care delivered in the beneficiary’s home without geographic restrictions and via audio-only when video is not feasible. Feldman emphasized the importance of telehealth for rheumatology patients, many of whom have mobility limitations or live in areas with limited access to specialists.

But, Harvey cautioned that these policies are not a permanent solution. “It is a major win, but it is temporary,” he said. “Congress should make these telehealth flexibilities permanent to reduce disruption, support long-term care planning, and ensure consistent access for Medicare beneficiaries.”

Looking Ahead

Ongoing lobbying efforts will be critical to ensure these issues remain a priority for legislators. “It is the perform the ACR does with its internal advocacy team and with key partners such as CSRO and the AMA that make these successes possible,” Harvey added. “As we can see, many if not all of these issues have bipartisan support and are simply awaiting a legislative vehicle to cross the finish line.”

For more information:

• William F. Harvey, MD, MSc, FACR, can be reached at tarnold@rheumatology.org.
• Madelaine Feldman, MD, FACR can be reached at madelainefeldman@gmail.com.