By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy
Imagine a scenario where every aspect of your healthcare is owned by the same company—your health insurance, your doctor, your pharmacist, and the company that manufactures the medication you’ve just purchased. For many Americans, this is already a reality.
Enter CVS Health.
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| Photo Source: Barchart |
When most people hear “CVS,” they think of the national chain of pharmacies with over 9,000 locations across the United States. They think of either filling a prescription, buying a holiday greeting card, or buying other small retail items.
What they don’t often think of is the fact that CVS Health doesn’t just own pharmacies; they own:
- Aetna, the health insurance giant serving over 36 million Americans;
- Oak Street Health medical clinics, the American Association of Retired Persons (AARP)-approved primary care provider for older and disabled Americans on Medicare;
- CVS Caremark, the pharmacy benefit manager (PBM) that negotiates drug prices that patients pay and which processes nearly 30% of all prescriptions in the United States in a given year; and,
- Cordavis, a relatively new pharmaceutical company created by CVS to manufacture biosimilar medications.
As Representative Alexandria Ocasio-Cortez (D-NY-14), during a hearing in the Health Subcommittee of the Committee on Energy and Commerce, put it when questioning CVS Health’s CEO, “Mr. Joyner, this is quite a bit of market concentration. Wouldn't you agree?” (AOC, 2026).
Joyner’s response was typical of companies that control a monopoly:
“No, I wouldn't agree that it's market concentration. I would suggest it's a model that works really well for the consumer.” (AOC, 2026).
CVS Health’s former CEO, Karen S. Lynch, very succinctly summed up the company’s strategy in 2024:
Many of our four million Medicare Advantage members can have access to our Oak Street clinics. We have a captive audience with benefit designs that can support the physicians [in the clinics]. We can drive patients to [the Oak Street health centers] (Japsen, 2024).
The often glib responses from health insurance CEOs did not go unnoticed in the Senate.
On February 11th, Senators Elizabeth Warren (D-MA) (seen right) and Josh Hawley (R-MO) (seen left) introduced the “Break Up Big Medicine Act of 2026,” a bill that would prevent PBMs, insurers, and prescription drug and medical device wholesalers from being owned by the same company.
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| Photo Source: The Wall Street Journal |
The “Break Up Big Medicine Act of 2026” would:
- Prohibit a parent company from owning a medical provider or management services organization and a PBM or an insurer;
- Prohibit a parent company of a prescription drug or medical device wholesaler from owning a medical provider or management services organization;
- Require that a company in violation of these provisions come into compliance within one year of the bill’s enactment;
- Create automatic penalties if a company fails to comply in a timely manner, including disgorgement of profits and forced sales of assets;
- Enable the Federal Trade Commission (FTC), Department of Health and Human Services, Department of Justice (DOJ), state attorneys general, and private parties to bring lawsuits against violators; and
- Allow the FTC and DOJ to review and block future actions that would recreate the conflicts of interest prevented by the bill (Elizabeth Warren, 2026).
Essentially, this bill aims to break up healthcare monopolies in the United States.
About the legislation, Senator Hawley said:
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. Working Americans deserve better. This bipartisan legislation is a massive step towards making healthcare affordable for every American (Josh Hawley, 2026).
Senator Warren echoed:
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. Our bill would be a monumental step towards ending the stranglehold that corporate giants have on our broken health care system (Elizabeth Warren, 2026).
The CVS Health example is a classic case of a monopoly that should have been broken up before it even got started… but, since the 1980s, enforcement of antitrust and monopoly laws in the U.S. has been… spotty, at best.
Over time, more and more aspects of American society, life, and commerce have become “vertically integrated,” meaning that businesses—particularly in the technology and health sectors—have gone out of their way to purchase and control multiple stages and steps of supply chains.
According to many of the businesses that control these monopolies (e.g., Google, Amazon, Meta), these purchases are “great for consumers” because they centralize purchasing and make things “easier.”
As Mr. Joyner from CVS Health would argue, “…it's a model that works really well for the consumer.”
Matt Toresco, Founder and CEO of Archo Advocacy and Co-Founder of We The Patients, is a leading voice in patient advocacy. Toresco further highlights this issue:
Vertical integration industrializes the problem. It does not create it. The deeper issue is that we built a system where financial entities control access to care without carrying medical liability for the consequences. Insurers shape treatment through coverage design. Step edits. Fail first protocols. Closed formularies. Technically, they do not practice medicine. Operationally, they influence it every day. If a delay harms a patient, the physician carries the malpractice risk. The insurer carries none. That asymmetry drives everything. You can reduce integration. If you do not align authority with accountability, you will reorganize power instead of reforming it (Toresco, 2026).
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| Photo Source: AntiTrust Law Journal LinkedIn |
A working paper published in the Antitrust Law Journal neatly summed up the lack of enforcement:
The decline of antitrust enforcement from the 1970s to the present was not achieved through legislative reform in response to public demand. It was the result of decisions made mostly in the shadow by politically unaccountable officials—judges and regulators—whose views of antitrust at the time of their appointment were (in most cases) not publicly known or perhaps even clear in their own minds.
To explore the potential forces behind this weakening, we considered two alternative hypotheses. The first is that these actions were the result of an enlightened elite of technocrats who promoted efficiency against the will of a Congress dominated by irrational populistic hostility to big business The alternative view is that big business drove a steady decline in antitrust enforcement against the public will to benefit itself. While we have no smoking gun, the evidence we collected provides more support to the second hypothesis than the first (Lancieri, Posner, & Zingales, 2022).
So, will the Break Up Big Medicine Act succeed?
Well, it’s hard to say.
But it’s a great first step.
Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.
References:
[1] Alexandria Ocasio-Cortez. (2026, January 22). ICYMI: Ocasio-Cortez Calls Out CVS Health’s Corporate Strategy to Monopolize Patient Care. Alexandria Ocasio-Cortez: Press: Press Releases. https://ocasio-cortez.house.gov/media/press-releases/icymi-ocasio-cortez-calls-out-cvs-healths-corporate-strategy-monopolize
[2] Elizabeth Warren. (2026, February 10). Warren, Hawley Introduce Bipartisan Bill to Break Up Big Medicine. Elizabeth Warren: Newsroom: Press Releases. https://www.warren.senate.gov/newsroom/press-releases/warren-hawley-introduce-bipartisan-bill-to-break-up-big-medicine
[3] Japsen, B. (2024, February 08). CVS Stays With Clinic Expansion Strategy Despite Walgreens Woes. New York, NY: Forbes. https://www.forbes.com/sites/brucejapsen/2024/02/08/cvs-sticking-with-clinic-expansion-strategy-despite-walgreens-woes/
[4] Josh Hawley. (2026, February 11). Hawley, Warren Introduce Bill to Break Up Big Medicine. Josh Hawley. https://www.hawley.senate.gov/hawley-warren-introduce-bill-to-break-up-big-medicine/
[5] Lancieri, F., Posner, E. A., & Zingales, L. (2022, August). The Political Economy of the Decline of Antitrust Enforcement in the United States. Antitrust Law Journal, 85(2), 442-519. https://www.americanbar.org/content/dam/aba/publications/antitrust/journal/85/2/political-economy-decline-of-enforcement.pdf
[6] Toresco, M. (2026, February 26). BREAKING UP BIG MEDICINE WON'T FIX HEALTHCARE UNTIL WE BREAK UP STATE MONOPOLIES. Charleston, SC: Archo Advocacy: Archo Advocate Brief: Posts. https://archo-advocate-brief.beehiiv.com/p/breaking-up-big-medicine-won-t-fix-healthcare-until-we-break-up-state-monopolies
