Sens. Elizabeth Warren (D-Mass.) and Josh Hawley (R-Mo.) introduced the Break Up Big Medicine Act on Feb. 9 to break up large health care conglomerates.

The law would forbid any parent company from owning a mix of health insurers, pharmacy benefit managers, drug wholesalers, medical providers, or related management organizations.

A company engaged in such ownership arrangements would have one year from the date of the bill’s enactment to come into compliance. Violators would be required to forfeit profits or sell assets.

Additionally, the act would enable government agencies and non-governmental actors to file lawsuits against violators and screen their future business activities.

Structural conflicts of interest within corporate giants can drive up prices and squash competition, according to a statement from Warren and Hawley.

“There’s no question that massive health care companies have created layers of complexity to jack up the price of everything from prescription drugs to a visit to the doctor. The only way to make health care more affordable is to break up these health care conglomerates,” Warren said.

“Our bill would be a monumental step towards ending the stranglehold that corporate giants have on our broken health care system.”

Cardiologist Anish Koka called the bill a bad idea on social media. “The government has no business deciding which private businesses to break up,” Koka wrote. “Just go after the myriad of regulations that lead to consolidation and [that] keep entry barriers for competition high.”

Vertical Integration

A 2025 American Medical Association (AMA) report found that a handful of health care giants are dominating the industry through the vertical integration of insurers and pharmacy benefit managers.

The top three pharmacy benefit managers—CVS Caremark, Express Scripts, and OptumRx—manage 79 percent of prescription drug claims for about 270 million Americans, according to a 2024 Federal Trade Commission report.

Each is owned by a company—CVS Health, Cigna, and UnitedHealth Group, respectively—that also operates its own health insurance company, doctors’ offices, and pharmacy.

Highly concentrated markets stifle competition and pose risks such as higher insurance premiums and reduced drug price transparency, according to the AMA report.

The report also found that the merging of services across different health care sectors creates increasing challenges for antitrust authorities in seeking to regulate the industry effectively.

Vertically integrated corporations can control the entire health care supply chain, according to the antitrust advocacy group American Economic Liberties Project. That includes the insurers that pay for care, the providers that deliver it, and the pharmacy benefit managers that set drug prices.

Big drug wholesalers have seen an increase in vertical integration, according to a Feb. 9 memo from the House Committee on Energy and Commerce’s Subcommittee on Health.

Three dominant wholesalers—Cardinal Health, McKesson, and Cencora (formerly AmerisourceBergen)—control over 90 percent of the drug distribution market, the memo states.

Large corporations can manipulate the system for profit, according to the memorandum, which hurts patients and taxpayers, and makes it difficult for independent pharmacies to compete, Warren said in her statement in support of the bill.

“Americans are paying more and more for healthcare while the quality of care gets worse and worse. In their quest to put profits over people, Big Pharma and the insurance companies continue to gobble up every independent healthcare provider and pharmacy they can find,” Hawley said in his statement.

According to a 2024 report from Physicians Advocacy Institute and Avalere Health, more than 127,000 independent physicians closed their private offices to join big health systems between 2019 and 2023.

Roughly 80 percent of independent pharmacists reported their business declined in 2024, while 30 percent of them considered closing stores in 2025, according to a National Community Pharmacists Association survey inquiring 8,000 pharmacy owners and managers.

Economic Liberties praised the introduction of the Break Up Big Medicine Act, calling it a “Glass-Steagall” moment for the health care industry.

The Glass-Steagall Act was landmark legislation that separated commercial banking from investment banking to address the financial crises and bank failures during the Great Depression.

“For decades, policymakers in both parties have incentivized vertical consolidation in health care, resulting in Big Medicine behemoths that exploit conflicts of interest to drive costs up, quality down, and independent providers out of business,” said Emma Freer, senior policy analyst for healthcare at the American Economic Liberties Project.