The Shrinking Number of Infectious Disease Doctors

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

Imagine having to travel 60 miles or more to reach an infectious disease (ID) physician who has the requisite expertise and training to address your HIV/AIDS. For many people living in nearly 80% of counties in the United States (n = 2,499), this is a reality (Figure 1; Walensky et al., 2020).

Figure 1 – ID Physician Density per 100,000 Population, by County

Photo Source: Walensky et al., 2020

This shortage of ID physicians isn’t new; for nearly a decade, the Infectious Diseases Society of America (IDSA) has been attempting to recruit aspiring or existing physicians into the field (Thompson, 2022), but those efforts have largely fallen flat.

In 2008, there were 6,424 physicians in the U.S. with active ID licenses; by 2018, that number was 9,136 (a 42% increase over 10 years); by 2025, however, it was just 9,774—barely a 7% increase over 7 years (Bearman et al., 2025).

So…what’s driving this shortage?

As with most things American Healthcare System-related, much of the issue has to do with money. Infectious disease doctors are historically paid less than physicians in other specialties, such as cardiology and gastroenterology (Goldman, 2026). According to the IDSA:

• The average medical student carries more than $241,000 in educational debt
• ID physicians make on average $260,000/year compared to those working in plastic surgery ($575,000/year), orthopedics ($557,000/year), cardiology ($490,000/year). According to the IDSA, of the fields measures, ID was the fifth-lowest paid specialty out of 29 fields examined (Figure 2, IDSA, 2022)

Figure 2 - Physician Compensation for Infectious Diseases Specialists Lower than Most Specialists

Photo Source: IDSA, 2022

In addition to financial issues, other issues exist that make placing ID physicians in unserved or underserved counties.

Rural counties are simply unable to attract and retain talent.

One of the primary issues that exists across the economy is the fact that rural areas simply lack much of what educated professionals want:

1. Available affordable housing
2. High-quality infrastructure, including safe, well-maintained roads, reliable utilities, including heating, electricity, and mobile phone coverage, and close, reliable emergency services, including law enforcement, fire departments, and other emergency personnel
3. Good schools that can provide any existing or potential children with a quality educational experience
4. Strong, inclusive communities that are welcoming to and accepting of non-White, non-Christian professionals
5. Close proximity to entertainment and dining opportunities
6. Close proximity to healthcare services other than those provided by the physicians themselves

The reality for many people who move to rural areas is that the touted “benefits” of living in rural communities, including more physical space, lower costs of living, a slower pace of living, and “fresh air,” as the Green Acres theme song reminded us, are simply outweighed by the inconveniences of rural life.

For patients in these unserved and underserved counties, however, they don’t really care why ID physicians aren’t located near them; they only care that they aren’t.

Photo Source: PlusInc | iStock

If you were to explain to patients with chronic illnesses that it’s hard to fill a position that pays “just” $260,000/year, you would likely be met with disbelief and scorn. When nearly 40% of people living in rural areas have median incomes of less than $50,000/year, trying to sell them the line that “ID physicians just don’t make enough” is a very hard sell (Federal Housing Finance Agency, 2024).

For many people dedicated to rural living, it’s hard to understand why people would want to live anywhere else. And this is part of the problem: if your area offers little in the way of modern comforts, job security, and job growth potential, it’s no big surprise that people who live there want to leave, and those who don’t live there want to avoid it.

And while 65% of nonmetro counties have seen population growth since 2020, almost all of that growth has come not from domestic relocation, but from international/foreign migration (United States Department of Agriculture, 2026).

All of these issues combined make for a bleak picture.

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] Bearman, G., Mullin, R., & Nori, P. (2025, December 10). The Receding Specialty of Infectious Diseases and Implications for U.S. Healthcare. Open Forum Infectious Diseases, 12(12), ofaf756. https://doi.org/10.1093/ofid/ofaf756

[2] Federal Housing Financing Agency. (2024, December 23). Who Lives in Rural America? Washington, DC: Federal Housing Financing Agency: Blog: Insights. https://www.fhfa.gov/blog/insights/who-lives-in-rural-america

[3] Goldman, M. (2025, March 02). Why new doctors aren't specializing in infectious diseases. Arlington, VA: Axios. https://www.axios.com/2026/03/02/doctors-not-specializing-infectious-diseases

[4] Maamari, J., Chen, Z., Motairek, I., Al-Kindi, S., & Fleisher, J. (2024, April 18). Mapping Proximity to Infectious Disease Physicians Across the United States. Open Forum Infectious Diseases, 11(5), ofae208. https://doi.org/10.1093/ofid/ofae208

[5] Sajani, A. (2024, August 05). The infectious disease doctor shortage will hit marginalized people the hardest. Boston, MA: STAT. https://www.statnews.com/2024/08/05/infectious-disease-doctor-shortage-bio-preparedness-workforce-pilot-program/

[6] Thompson, D. (2022, December 19). America Facing Shortage of Infectious Disease Doctors. Norwalk, CT: HealthDay: Health News: Public Health. https://www.healthday.com/health-news/public-health/physicians-2658968654.html

[7] United States Department of Agriculture. (2026, February 13). Population & Migration. Washington, DC: United States Department of Agriculture: Economic Research Service: Rural Economy Population. https://www.ers.usda.gov/topics/rural-economy-population/population-migration

[8] Walensky, R. P., McQuillen, D. P., Shahbazi, S., & Goodson, J. D. (2020, June 03). Where Is the ID in COVID-19? Annals of Internal Medicine, 173(7), 587-589. https://doi.org/10.7326/M20-2684

NASTAD Releases 2026 ADAP Monitoring Report: Warning Signs Ahead

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

The National Alliance of State and Territorial AIDS Directors (NASTAD) has released its annual National Ryan White HIV/AIDS Program (RWHAP) Part B ADAP Monitoring Report. Highlights from the report indicate that, while the program is achieving the goal of helping ADAP recipients suppress their HIV, the failure of governments to adequately fund state programs and those programs’ increasing reliance on drug rebates imperils the lives of those recipients (NASTAD, 2026a).

Photo Source: NASTAD

The 2026 ADAP Monitoring Report includes findings from Fiscal Year 2024 (FY2024) and Calendar Year 2024 (CY2024) and relies on state and territorial ADAPs to respond to NASTAD’s inquiries about their programs to ensure that the information provided therein is as accurate as possible. That said, 2 U.S. states (Mississippi and West Virginia) and 7 territories (American Samoa, the Federated States of Micronesia, Guam, Marshall Islands, the Northern Mariana Islands, the Republic of Palau, and the U.S.).S. Virgin Islands) failed to respond to these inquiries.

What’s Working Well

Viral Suppression

87% of ADAP recipients in FY/CY2024 achieved viral suppression. This is a considerable improvement over the 74% suppression rate in FY/CY2024 and much better than the national suppression rate of 67%.

HIV suppression rates in the United States have consistently lagged behind those of economically comparable nations (Figure 1). Compared to similar nations, the U.S. HIV viral suppression rate tends to fluctuate between 57% and 67%, while other nations range from 72% (Canada) to 92% (United Kingdom). Persons Living with HIV/AIDS (PLWHA) who are enrolled in ADAP have achieved viral suppression rates that allow the U.S. to “compete” with other nations.

The primary difference between the U.S. and other nations is that those nations provide universal healthcare coverage, allowing patients to rest assured that their HIV medications will be covered. Comparatively, PLWHA in the United States must contend with significant barriers to accessing HIV care and treatment due to our nation’s reliance on a for-profit healthcare system that prioritizes profits over health outcomes. The ADAP program has allowed patients similar surety that they will have access to the medications they need to live healthy, productive lives

Figure 1 - HIV Viral Suppression Rate in the U.S. Lowest Among Comparable High-Income Countries

Photo Source: KFF

Whom ADAP Served in FY/CY2024

In CY2024, ADAPs served 257,644 individual clients across 49 reporting jurisdictions, acting as the primary access point for nearly one-quarter (23%) of the 1.13 million people aged 13 years or older living with diagnosed HIV in the United States at the end of 2023.

This represents a 7.5% increase over CY2019 levels, and NASTAD notes that this increase underscores patients’ growing reliance on the program despite the full implementation of the Affordable Care Act (ACA).

In FY/CY2024, 40% of all ADAP program clients earned 100% or less of the Federal Poverty Level (FPL), and 65% earned 200% or less.

Additionally, nearly half of all ADAP clients (43%) are People of Color (POC), with 38% Black, slightly lower than the 40% who were Black in CY2019. 36% of ADAP clients identify as Hispanic/Latine, a significant increase from 28% in CY2019.

Finally, the majority of ADAP clients (55%) were aged 45 or older, with the proportion of clients aged 65 or older increasing from 9% in CY2019 to 14% in CY2024.

NASTAD notes that the continued “greying” of ADAP enrollees will necessitate “…robust coordination between ADAPs and Medicare to ensure seamless coverage for the aging caseload.”

How ADAP Clients Are Served

Because the AIDS Drug Assistance Program is federally funded but state-administered, each state is allowed to determine how it serves ADAP clients. The traditional ADAP program provides full-pay medication coverage for clients, on which 47% rely.

Since the passage of the Affordable Care Act (ACA), however, the Health Resources Services Administration (HRSA) has allowed state ADAPs to use funds to purchase commercial health insurance coverage for ADAP clients and to reimburse those with employer-sponsored insurance coverage. 41% of clients across the United States rely on the ADAP program for said coverage.

Additionally, 12% of clients rely on a combination of full-pay and insurance support to address critical coverage gaps between drug formularies.

Trouble on the Horizon

In addition to the positive impacts ADAPs have had on clients, significant issues loom over state and territorial programs that threaten their solvency and continued effectiveness.

Rising Costs

The most pressing concerns faced by state ADAPs is that healthcare costs have risen exponentially and are likely to continue rising as a result of both Congressional inaction to increase federal funding for RWHAP and the deliberate refusal of Congressional Republicans to extend the enhance premium tax credits implemented by the American Rescue Plan Act of 2021 (ARPA) and extended by the Inflation Reduction Act of 2022 (IRA).

These tax credits were implemented to lower ACA Marketplace premiums for all patients, and Congress’s refusal to extend them resulted in a 21.7% increase in Marketplace premiums for benchmark second-lowest-cost Silver plans and 6%- 7% increases in employer-sponsored insurance premiums (Holahan, O’Brien, & Kennedy, 2025).

These premium increases highlight what many advocates have argued since the passage of the ACA: The ACA was never likely to control insurance costs because no limits were placed on annual premium price increases.

The primary failure of the American healthcare system is its convoluted, fragmented nature, full of special-interest-driven loopholes. The current “market” theory relies not on patients who need care, but rather on what insurers and government payors are willing to pay.

For-profit entities do not, in fact, care whether or not patients can afford the care they need; that’s not their purpose. Their purpose is to generate profits for their companies and their shareholders.

This results in a system where patients have to forego care and potentially die in the richest nation on the planet.

For ADAPs, these increased premiums pose significant threats to annual budgets, which increasingly rely on medication rebates to fill their coffers.

For nearly a decade, federal funding for ADAP has remained largely flat despite rising costs. In fact, federal funding has not accounted for more than 50% of annual ADAP funding since 2008 (Figure 2). Meanwhile, rebates now account for more than 50% of annual ADAP budgets.

Figure 2 - Total ADAP Budget, By Source, FY1996–FY2024

Photo Source: NASTAD

This places ADAPs at significant risk of being unable to continue providing the level of care and services they offer due to a revenue mechanism subject to “…intense market and regulatory volatility.”

What does this phrase mean?

Essentially, rebates rely on two things: high drug list prices and low 340B purchase prices. Under the rebate model, programs purchase medications at full list price and are reimbursed by pharmaceutical manufacturers for the difference between list price and 340B purchase price.

But what happens when price controls, such as those implemented under the Medicare Drug Negotiation Program created by the IRA, are introduced?

The purpose of the Medicare Drug Price Negotiations is to essentially limit what pharmaceutical manufacturers can charge the federal Medicare program for their medications. This means that a drug with an annual Wholesale Acquisition Cost of $36,000 may be forced to sell its medication to Medicare for $16,000 per year, which significantly reduces the total rebate amount that ADAP pharmacies may receive.

This doesn’t just apply to medications that treat HIV, but to every medication eligible for 340B rebates.

The reality is that, if patients get their way, government price controls are all but assured.

73% of patients surveyed in 2023 said that there was not enough government regulation when it comes to limiting the price of prescription drugs, with 67% or more of respondents agreeing with that sentiment across party affiliation (82% of Democrats, 67% of Independents, and 68% of Republicans; Sparks et al., 2024).

This finding wasn’t a one-time fluke; patients have long been in favor of significant increases in government regulations as they relate to controlling prescription drug prices, with 88% of patients being in favor of limiting annual drug price increases to no more than the rate of inflation, 88% of patients being in favor of the government negotiation drug prices for the Medicare program, 78% being in favor of importing drugs from Canada, 72% being in favor of increasing taxes on pharmaceutical companies that refuse to negotiate prices with the federal government, 63% being in favor of increases taxes on companies who drug prices are too high, and 57% being in favor of ending tax breaks given to drug companies for advertising spending.

What this could mean for state ADAPs is that, with increased patient fury at the healthcare industry and systems, in general, elected officials are more likely to begin listening to patients than to industries. Should significant price controls be implemented, the rebate model could collapse, leaving ADAPs facing the loss of 50% or more of their annual operating budgets.

How Are ADAPs Responding

Faced with the various funding hurdles, state and territorial ADAPs are beginning to implement “cost containment” measures (translation: cuts) that will result in significant negative outcomes for the patients who rely upon ADAP for their HIV medications.

These “cost containment” measures include (but are not limited to):

• Decreasing income eligibility requirements so that fewer PLWHA are eligible for benefits
• Delaware eligibility decreased from 500% of the FPL to 350%, effective for all clients as of April 1st, 2026, impacting ~176 patients
• Florida decreased from 400% to 130% of the FPL effective March 1st, 2026, impacting ~16,000 patients
• Kansas decreased from 400% to 250% of the FPL to receive ACA premium assistance, while maintaining the 400% limit for full-pay medication coverage, impacting ~230 patients
• Pennsylvania decreased from 500% to 350% of the FPL effective October 1st, 2026, impacting ~1,592 patients
• Rhode Island decreased from 500% to 400% of the FPL effective March 1st, 2026, impacting ~51 clients
• The following states are considering additional changes to income eligibility:
• Arkansas, Louisiana, New Jersey, Rhode Island, Virginia, & Washington State
• Reducing RWHAP Part B funding for core medical/support services
• Implemented in Arkansas, Connecticut, Delaware, Kansas, Louisiana, Michigan, Pennsylvania, Rhode Island, Virginia, & Wisconsin
• Implementing or reimplementing 6-month recertification requirements
• Implemented in Alaska, Oklahoma, & Rhode Island
• Introducing per-patient expenditure caps
• Implemented in Arizona, Colorado, Delaware, the District of Columbia, & Nevada
• Reducing formulary coverage for both HIV-related and non-HIV-related medications
• Implemented in Arizona, Florida, Louisiana, Michigan, Nevada, & Pennsylvania
• Decreasing, restricting, or eliminating insurance premium assistance
• Implemented in Florida, Michigan, Montana, Oklahoma, & Wisconsin (NASTAD, 2026b)

HIV advocates and activists are also concerned about the potential reintroduction of state ADAP program waitlists, with Arkansas, Louisiana, & New Jersey reporting that they are considering implementing waitlists (NASTAD, 2026b).

The reality of this landscape is that trouble is brewing for RWHAP and the PLWHA who depend upon its various parts and programs to stay alive. ADAP Advocacy will continue to monitor and report on circumstances as they develop.

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] Holahan, J., O’Brien, C., & Kennedy, N. (2025, December 18). Understanding the Extraordinary Increase in ACA Premiums in 2026. Washington, DC: Urban Institute: Research: Publication. https://www.urban.org/research/publication/understanding-extraordinary-increase-aca-premiums-2026

[2] KFF. (2025, January 24). HIV Viral Suppression Rate in U.S. Lowest Among Comparable High-Income Countries. Washington, DC: KFF: HIV/AIDS. https://www.kff.org/hiv-aids/hiv-viral-suppression-rate-in-u-s-lowest-among-comparable-high-income-countries/

[3] National Alliance of State and Territorial AIDS Directors. (2026a). 2026 National Ryan White HIV/AIDS Program Part B ADAP Monitoring Project Annual Report: Stabilizing the Safety Net: Stewardship and Outcomes in a Volatile Landscape. Washington, DC: National Alliance of State and Territorial AIDS Directors. https://nastad.org/2026-rwhap-part-b-adap-monitoring-report

[4] National Alliance of State and Territorial AIDS Directors. (2026b, February 09). NASTAD ADAP Watch - February 2026. Washington, DC: National Alliance of State and Territorial AIDS Directors. https://nastad.org/resources/nastad-adap-watch-february-2026

[5] Sparks, G., Kirzinger, A., Montero, A., Valdes, I., & Hamel, L. (2024, October 04). Public Opinion on Prescription Drugs and Their Prices. Washington, DC: KFF: Health Costs. https://www.kff.org/health-costs/public-opinion-on-prescription-drugs-and-their-prices/

The Medical Monopolies Monopolizing Modern Medicine

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.

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.

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).

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