The Break Up Big Medicine Act requires structural separation in the healthcare industry by prohibiting companies from simultaneously owning both insurance companies or pharmacy benefit managers and healthcare providers, drug wholesalers, or medical device distributors. The bill, which Congress supports based on findings that consolidation has created dangerous conflicts of interest—such as the three largest pharmacy benefit managers processing 80% of prescription claims and the three largest drug wholesalers controlling 98% of distribution—mandates that violating companies divest one business category within one year or face escalating monthly financial penalties. Enforcement is shared between the FTC and DOJ, which can appoint trustees to force asset sales if companies fail to comply voluntarily, while individuals harmed by violations can sue for triple damages and attorney fees. The law targets intermediary distributors and vertically integrated conglomerates while explicitly exempting licensed pharmacies, hospitals, manufacturers, and logistics providers from its scope.
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