Trump’s role as “kingmaker” continues in Republican primaries; What it could mean for future health care debates
President Trump continued his unprecedented success in choosing the winner in Republican primaries with the defeat of Texas Sen. John Cornyn (R) last week. Ken Paxton’s defeat of Cornyn comes after Trump’s endorsement proved pivotal in defeating a number of federal and state candidates, including Louisiana Sen. Bill Cassidy (R), Texas Reps. Chip Roy (R) and Dan Crenshaw (R), Kentucky Rep. Thomas Massie (R) and six Indiana state senators who voted against a congressional redistricting bill backed by Trump. Trump has endorsed Republican candidates in 295 primaries for the 2026 cycle so far, and his endorsed candidates have not lost a single race — a perfect 100% success rate. Those wins include 110 congressional primaries (101 House races and 9 Senate contests), along with 8 gubernatorial campaigns. This winning streak means more Trump-aligned Republican members of the U.S. House and Senate and the loss of long-standing health care-focused legislators. For example, Sen. Cassidy has long advocated for a robust U.S. public health system and generally supported positions favored by the biopharmaceutical industry, while Sen. Cornyn has been a tenured defender of robust U.S. intellectual property (IP) protections. Their shoes will be difficult to fill on a variety of issues. Gridiron’s Take: More Trump-aligned members of the GOP caucus likely mean a more favorable reception to issues such as Most Favored Nation (MFN)/international drug pricing policies and general support for government negotiation of drug prices—-positions not supported by more traditional Republicans, most of whom support a free market U.S. health care system and scoff at government price controls. While the biopharmaceutical has traditionally taken Republican support for granted (at least on issues such as government price controls), Trump’s nontraditional/populist approach to these issues has changed the landscape, potentially long-term. Looking beyond the November mid-term elections, if Democrats succeed in taking back both the U.S. House and Senate (which Polymarket and various pundits have as a very real possibility—with the Democrats heavily favored to win the House and the Senate currently viewed as a “toss-up”) there is a plausible path for nefarious drug pricing legislation (potentially expanding drug negotiation provisions within the IRA or MFN-style legislation) to pass in a Democrat-controlled House and Senate and signed by President Trump. While Trump and HHS Secretary Kennedy may seem constantly at odds with the leaders like Sen. Bernie Sanders (I-VT) and Sen. Elizabeth Warren (D-MA), on many prescription drug pricing issues there isn’t much distance between their positions. We’ll drive deeper into what the polls and pundits think about potential future control of Congress in next month’s issue of the Public Policy Snapshot.
Virginia Governor stands firm and issues second veto of Prescription Drug Affordability Board (PDAB) legislation
Virginia Governor Abigial Spanberger (D) vetoed the prescription drug affordability board legislation (HB 483 and SB 271) for the second time on Tuesday, May 19. She’s the first Democratic governor to stand strong against ongoing efforts to establish PDABs at the state level. This marks the third veto of such a proposal between two Virginia governors, making it a five-year effort that has now come up short again. Spanberger’s Republican predecessor Glenn Youngkin had vetoed similar legislation in 2024 and 2025, making this the fifth overall attempt to create such a board. This year’s version had been rebranded as the “Affordable Medicine Act” and passed the House of Delegates 95-4 and the state Senate 34-6 — an overwhelming bipartisan majority. Spanberger’s reasoning for the vetoes: she argued that prescription drug affordability boards in other states have proven expensive and ineffective, saying “Evidence from other states clearly shows that Prescription Drug Affordability Boards do not achieve this goal. They are expensive undertakings that other states have either repealed or are considering repealing.” She had proposed amendments that would have changed the board into a panel to study a reference-based pricing system before the state spent millions on implementation, but the General Assembly rejected those amendments, sending the original bill back to Spanberger. The veto drew sharp criticism. AARP Virginia had urged her to sign the bill, noting that 84% of Virginians support the policy. Even some Republican state senators who had supported the bill called it “stunning” given Spanberger’s campaign emphasis on affordability. Rare disease advocates hailed the decision: “This is a major victory for rare disease patients, caregivers, advocates and the broader patient community who raised concerns about policies that could have threatened access to lifesaving and specialized treatments,” the Rare Access Action Project (RAAP) said in a statement. The Biotechnology Innovation Organization (BIO) also praised the veto, with BIO’s Patrick Plues saying, “We look forward to working with the Governor’s Administration, the General Assembly, Virginia Bio and other stakeholders to advance practical, patient-centered policy solutions that improve affordability while preserving access to care and the innovation ecosystem patients depend
Tennessee becomes second state to ban Pharmacy Benefit Manager “vertical integration”
Tennessee Gov. Bill Lee signed the Tennessee Freedom, Access, and Integrity in Registered Pharmacy Act (FAIR Rx Act) into law on May 22, 2026. The legislation (SB 2040/HB 1959) prohibits a single company from operating a health plan, a pharmacy benefit manager (PBM), and a pharmacy in the state simultaneously. Companies impacted by the bill would have until July 1, 2028 to make changes. The FAIR Rx Act passed with strong bipartisan support, clearing the Tennessee Senate 24–9 and the House 86-7. CVS filed a lawsuit immediately, claiming the law would force the closure of 134 pharmacies around the state. Tennessee is the second state to pass a law restricting PBMs from being vertically integrated with state pharmacies. Arkansas was the first — in April 2025 with plans to take effect on Jan. 1, 2026 — but the ban has been temporarily blocked while the state battles Caremark and Cigna’s Express Scripts in court. The National Association of Chain Drug Stores and the Tennessee Pharmacists Association celebrated the bill’s passage: “The signing of the FAIR Rx Act is a testament to what is possible when lawmakers, stakeholders, and advocates come together around good public policy,” said NACDS President and CEO Steven C. Anderson. “This landmark law takes a meaningful step toward ensuring that the rules governing pharmacy reimbursement are set fairly, supporting a marketplace where pharmacies can compete and patients can continue to access the care they need. We are grateful to the members of the General Assembly for their leadership and overwhelming bipartisan support, and to Governor Lee for signing this important legislation into law.” Interestingly, the Tennessee bill’s author, Rep. Bobby Harshbarger (R) is a practicing pharmacist. He is also the son of U.S. Rep. Diana Harshbarger (R) who, as a pharmacist and member of the powerful House Energy & Commerce Committee, is a leading voice in favor of PBM reform.
Key congressman calls on Administration to rein in US-China pharmaceutical dealmaking to protect American innovation
Leading voices in Congress continue express concern about the US-China partnerships in biotech innovation. Rep. John Moolenaar (R-MI), chairman of the House Select Committee on the Chinese Communist Party, issued a letter on May 20 to Treasury Secretary Scott Bessent to designate biotechnology as a “prohibited technology” under the Comprehensive Outbound Investment National Security (COINS) Act of 2025, urging the Treasury Department to block American investments in Chinese biotechnology companies and warning that U.S. capital and expertise are helping Beijing dominate the global pharmaceutical sector. Moolenaar reportedly is concerned that Bristol Myers Squibb (BMS) recently announced it had formed a broad partnership with Hengrui Pharma, paying $600 million upfront to advance 13 early-stage programs, with the deal potentially worth up to $15.2 billion. BMS received ex-China rights to four oncology and hematology assets from Hengrui, while granting Hengrui rights to four of its own immunology assets in China, Hong Kong, and Macau. Moolenaar specifically highlighted the BMS deal, stating that it clearly deals with co-development of drug molecules and transfer of intellectual property. “United States capital flowing to Chinese biotechnology companies through licensing agreements, joint ventures, and equity investments is fueling China’s strategy, aiding it in its rapid ascent up the pharmaceutical value chain,” Moolenaar wrote. “Cross-border out-licensing transactions between American and other multinational pharmaceutical firms and Chinese biotechnology firms totaled approximately $136 billion in 2025. Last year, 48% of all large pharmaceutical licensing deals globally of $50 million or more were inked with Chinese companies, up from 0% in 2020, and this trend is continuing to accelerate.” Moolenaar and other members of Congress have also raised concerns over China’s clinical trial system, describing it as “the cheapest and fastest human clinical trial system in the world” while alleging ethical concerns involving informed consent and involuntary participation. He further claimed that some clinical trials are conducted at hospitals in Xinjiang and Chinese military hospitals, potentially exposing sensitive American biotechnology data and intellectual property to the Chinese military. Concerns about US-China partnership in biotech will continue to be raised in Congress by members of both political parties. According to CNBC, more than half of large pharmaceutical companies’ licensing deals have come from China so far this year, up from 39% all of last year and just 5% in 2022.
Utah’s AI experiment in health care: Early results show strong AI-physician alignment in prescription medication renewals
Utah became the first state to allow patients to renew medical prescriptions using artificial intelligence, announcing a partnership with AI health company Doctronic in January 2026. Utah waived licensing laws for AI to refill common prescriptions, making it the first test of AI as an autonomous clinical decision-maker under a regulatory suspension paradigm. Doctronic’s AI operates within strict parameters and can process 30-, 60-, or 90-day renewals for medications that have already been prescribed by a licensed provider. Some of the medications the AI may refill include statins for high cholesterol, medications for high blood pressure, psychiatric medications, and birth control. Utah’s high-profile experiment faced its first major challenge as doctors in the state pushed back. The Utah Medical Licensing Board said it only learned about the agreement after the plan had been launched and asked the state to halt the program, stating that “proceeding with this agreement without consulting the Medical Board potentially places Utah citizens at risk.” Early five-month results from the Utah pilot were released on May 26, 2026. According to Doctronic, its AI system recommended prescription renewal in 72% of cases. In the remaining 28% of cases, AI escalated the case to a human physician due to case characteristics, including the need for new lab work or complications. Among the cases where the AI suggested a prescription renewal, the reviewing physician agreed that a renewal was appropriate based on the AI’s gathered information in 91% of cases. Critcs argue that the surveyed physicians were Doctronic’s own physicians, rather than a diverse cross-section of physicians without corporate ties. Other states are watching closely — Arizona and Texas have created AI regulatory flexibilities, and Wyoming is preparing its own — reflecting a growing national push for expanded pathways for autonomous AI in health care.
Health Policy Snippets
- House Republicans ask Congressional Budget Office: Where is the savings from the Inflation Reduction Act (IRA)? Key House health committee leaders are demanding the Congressional Budget Office (CBO) explain how it initially underestimated the cost of the Inflation Reduction’s Act Part D redesign, which is now set to cost significantly more than expected, while at the same time projecting savings from the drug negotiation program GOP lawmakers say haven’t been realized. House Energy & Commerce Committee Chair Brett Guthrie (R-KY), Ways & Means Committee chair Jason Smith (R-MO) and Budget Committee Chair Jodey Arrington (R-TX) include a slew of questions regarding the agency’s first estimates and subsequent revised determinations of the savings and costs associated with IRA price controls, like the drug price negotiation program and redesign of the Part D benefit, in a letter sent Wednesday, May 20 to CBO Director Phillip Swagel. “When CBO initially scored the Inflation Reduction Act (IRA), CBO estimated its three primary Medicare prescription drug provisions would result in a decrease in deficits of $129 billion. CBO has now conceded that the initial projections of those provisions have not come to fruition,” the lawmakers say in the letter. While key Republicans continue to oppose the Biden-era IRA law, the votes don’t exist for any substantial changes or repeal of the IRA. Democrats continue to tout the law’s passage as evidence of their commitment to lower health care costs. If Democrats secure majorities in the House and Senate after the mid-term elections, expect swift legislative attempts to expand the IRA and remove the language passed in 2025 to expand protection for orphan drugs (e.g. “Orphan CURES Act”).
