Democrats won majorities in both the House and Senate in the Nov. 3 midterms, giving the party control of Congress when the new session begins Jan. 3. Until then, Republicans retain control of both chambers.
President Donald Trump retains veto power, limiting Democrats’ ability to enact major policy changes without Republican support. But control of Congress gives Democrats power to set committee agendas, hold hearings, issue subpoenas and advance legislation. Here are six ways the shift could affect pharmacy:
- Drugmakers could face more congressional oversight. Since December 2025, top Democrats on four committees have sent letters to 15 drugmakers seeking details about the Trump administration’s pricing agreements, including how they affect Medicare. Democratic control gives committees stronger investigative tools, including hearings and subpoenas. Sen. Ron Wyden, D-Ore., who is set to lead the Senate Finance Committee, has also signaled that pharmaceutical pricing will be an oversight priority. The administration’s pricing agreements are tied in part to pharmaceutical tariffs, giving the committee another potential avenue for scrutiny.
- 340B could face more congressional scrutiny. Democrats and Republicans have both introduced 340B legislation, including several proposals to end or delay HRSA’s rebate pilot, which is set to start Jan. 1. CMS also finalized a Medicare payment cut for 340B drugs Nov. 4, at average sales price minus 28%. Democratic committee control creates another avenue for scrutiny of drugmakers, PBMs and federal agencies. Drugmakers’ 340B restrictions are also moving through the courts, including a suit by hospitals challenging Eli Lilly’s claims data requirement and cases against CVS over alleged 340B diversion.
- PBM reform could remain a bipartisan target. PBM oversight has been a bipartisan priority in Congress, and Democrats have signaled interest in going further. The Consolidated Appropriations Act of 2026’s requirement that any willing pharmacy be able to join Part D networks does not start until 2029. A Labor Department proposal also awaits finalization that would require PBMs to disclose actual dollar amounts of compensation, including manufacturer rebates, to employers before contracts are signed and in semiannual reports. Meanwhile, Arkansas’ ban on PBM ownership of pharmacies, which a federal judg blocked in July while litigation proceeds, is before the 8th Circuit.
- Medicaid and ACA policy could affect pharmacy payer mix. House Democrats’ first-100-days agenda includes restoring enhanced ACA premium subsidies that expired at the end of 2025 and reversing nearly $1 trillion in Medicaid cuts. Those proposals face significant hurdles, including President Trump’s veto power. Federal Medicaid changes are approaching in 2027, and some health systems are already scaling back capital plans ahead of them. Changes in coverage could affect health systems’ payer mix, uncompensated care and pharmacy finances.
- HHS and FDA decisions could draw more hearings and investigations. Democratic control is expected to bring greater congressional scrutiny of the Trump administration’s health policies. Sen. Bernie Sanders, I-Vt., is expected to return as chair of the Senate Health, Education, Labor and Pensions Committee, putting drug prices, HHS policy and other healthcare issues under a committee he previously led. Pharmacy-related decisions that could draw attention include HHS’ interim policy allowing pharmacies to compound six unapproved peptides.
- FDA user-fee reauthorization creates a major 2027 drug policy vehicle. FDA’s current prescription drug user-fee authority expires in September 2027, meaning Congress will need to pass new legislation for the agency to continue collecting those fees. The reauthorization process could give lawmakers an opportunity to attach or negotiate other FDA and pharmaceutical policy provisions.
