May 13, 2025
Health Policy Report – May 13, 2025
The US Oncology Network Participates in the Community Oncology Alliance’s Annual Conference
The US Oncology Network attended the Community Oncology Alliance’s (COA) annual conference on April 29th and 30th. This year’s theme, “Empower & Advocate: Independent Community Oncology,” provided a vibrant platform for discussions focused on enhancing access to community cancer care.
Ben Jones, our Senior Vice President of Government Relations & Marketing, shared his insights during a dynamic general session panel titled, “The Impact of Politics & Policy on Community Oncology.” He shed light on crucial topics such as the ongoing Congressional reconciliation process, legislation on patient access to oral oncolytics, PBM reform, physician reimbursement, and drug pricing—all pivotal issues impacting the field of oncology today.
Our Government Relations team recorded several episodes of “The Link” podcast, “Your link to the policies that matter most,” a series designed to connect physicians to policy. These episodes dive into the complexities of healthcare, providing valuable insights on issues impacting community oncology. Our distinguished guests included COA President and The Network’s Public Policy & Reimbursement Chair Dr. Debra Patt, COA Managing Director Nick Ferreyros, Rocky Mountain Cancer Center Executive Director and COA board member Glenn Balasky, along with other key Network stakeholders and subject matter experts.
We are delighted to have participated in such a successful and well-attended conference, showcasing the dynamic developments transforming community oncology.
To listen to previous episodes of The Link and tune into the COA recording sessions, CLICK HERE.
President Trump Signs Executive Order on Most Favored Nation Drug Pricing
On May 12, President Trump signed an Executive Order entitled “Delivering Most Favored Nation Prescription Drug Pricing to American Patients,” which would tie government payments for medications to the lower prices paid overseas.
During his first term, President Trump attempted to implement a model that would have applied to Medicare Part B, which covers drugs administered in a doctor’s office. The proposal faced significant legal challenges when the Centers for Medicare and Medicaid Services (CMS) formally rescinded the model, citing legal infirmities and stakeholder concerns.
White House officials have not yet disclosed which medications the most recent order will apply to, but the actions appear more aggressive than in his first term. Under the order, the Department of Health and Human Services (HHS) will negotiate direct-to-consumer prices “where appropriate” and Secretary Robert Kennedy, Jr. will be tasked with setting price targets for all U.S. markets within 30 days, which will open negotiations with the companies.
Stakeholder groups, like the Part B Access for Seniors and Physicians (ASP) Coalition, have long pushed against MFN drug policies. “Linking U.S. health care policy to other countries, that artificially suppress prices through access restrictions and subjective controls, would tie the hands of providers in the United States by narrowing and delaying access to available treatments due to market forces outside of their control,” the Part B ASP Coalition wrote in a statement.
The Network will continue engaging with stakeholders and will submit comments on any potential rulemaking as HHS works on this executive order.
To read the Part B ASP Coalition’s statement, CLICK HERE.
To read more, CLICK HERE.
Senator Joe Kennedy (R-LA) Introduces Bill on Site Neutral Payment Reform
On May 5, Senator Joe Kennedy (R-LA) introduced the Same Care, Lower Cost Act, which would more closely align Medicare payment rates for healthcare services across sites of service. If passed, the bill would direct the Secretary of Health and Human Services (HHS) to equalize payment rates for no less than 66 ambulatory payment classifications (APCs), which are used to determine payment for outpatient healthcare services.
The legislation codifies the Medicare Payment Advisory Commission’s (MedPAC) recommendation in its June 2023 report, which noted that such reforms would “lower Medicare program spending, lower beneficiary cost sharing, and provide an incentive for providers to improve efficiency by caring for patients in the lowest-cost site appropriate for their condition.” Further, as MedPAC has previously noted, this policy would bolster independent physician practices by removing the financial incentive for hospitals to acquire them and bill for services at a higher rate.
“Patients should only pay for the care they receive, not for the sign on the door or where they get treated. My Same Care, Lower Cost Act is a common-sense reform that expands patients’ health care options, creates greater transparency and reduces taxpayer burden,” said Kennedy in a statement.
To read more, CLICK HERE.
To read the MedPAC report, CLICK HERE.
House Energy & Commerce and House Ways & Means Set for Reconciliation Markup
Following continued debate over spending cuts to Medicaid, House Republicans released the draft text of their budget reconciliation plan. The draft text includes significant changes to Medicaid, including work requirements, more frequent eligibility checks on beneficiaries, and changes to the way that states raise their share of Medicaid funding.
“Medicaid waste and abuse threatens the well-being of America’s most vulnerable as the looming expiration of important 2017 tax reforms throws a shadow over U.S. industry,” Energy and Commerce Chairman Brett Guthrie (R-KY) wrote in the Wall Street Journal. “Republicans’ best chance to secure the president’s inaugural promise is this year’s reconciliation bill.”
In response, Energy and Commerce (E&C) ranking member Frank Pallone Jr., (D-NJ) said in a statement that “in no uncertain terms, millions of Americans will lose their health care coverage, hospitals will close, seniors will not be able to access the care they need, and premiums will rise for millions of people if this bill passes.”
Importantly, however, the draft text of the reconciliation package includes an inflation-based payment update for physicians under the Medicare Physician Fee Schedule (MPFS). This was a major priority of physician advocacy groups after the so-called “doc fix” was left out of a continuing resolution (CR) in March.
The release of the draft text comes after House Republicans postponed the Energy & Commerce and Ways & Means Committee markups of the budget reconciliation package, which are now scheduled to begin in the afternoon on Tuesday, May 13 and is expected to go late into the evening.
To read more, CLICK HERE.
To read Congressman Guthrie’s op-ed, CLICK HERE.
To read Congressman Pallone’s statement, CLICK HERE.
To watch the Ways and Means markup, CLICK HERE.
To watch the Energy and Commerce markup, CLICK HERE.
Milliman Report Shows Impact of the Inflation Reduction Act
On May 9, Milliman released a new report showing the potential impact of the Inflation Reduction Act (IRA) and its changes to Medicare Part B reimbursement on physician reimbursement and patient access to care.
Under the IRA as written, provider reimbursement for Part B drugs will change from being tied to Average Sales Price (ASP) to being tied to Maximum Fair Prices (MFPs) for selected drugs. This change is estimated to decrease provider reimbursement by $53.6 billion over 10 years.
The study also examines the Protecting Patient Access to Cancer and Complex Therapies Act (PACTA), which was originally introduced by Senator John Barrasso (R-WY) and now retired Congressman Michael Burgess, MD (R-TX) in September 2023. If passed, the bill would amend the IRA to keep physician reimbursement ASP-based and instead create an additional rebate paid by manufacturers.
In examining both models, the study showed that Inflation Reduction Act’s net cost to oncology providers would be $26,927 over ten years, the highest of the specialties examined.
To read the study, CLICK HERE.
White House Releases 2026 Budget, Includes Cuts to HHS
The White House has released a 2026 budget that would cut $33.3 billion in discretionary funding for the Department of Health & Human Services (HHS). In the budget document, the White House noted its view that the cuts are necessary to reduce fraud, waste, and abuse at HHS agencies.
Under the proposal, $674 million would be cut from the Centers for Medicare & Medicaid, $3.7 billion from the Centers for Disease Control and Prevention (CDC), and $18 billion from the National Institutes of Health (NIH). The budget does provide $500 million to HHS Secretary Kennedy’s Make America Healthy Again (MAHA) Commission.
Medical and advocacy groups criticized the proposal, noting that such cuts would harm the nation’s healthcare infrastructure. The budget likely faces pushback on Capitol Hill, as slashes in research funding have drawn opposition, including from top Republicans like Susan Collins (R-ME).
To read more, CLICK HERE.
Senators Rounds and Heinrich Introduce the Health Tech Investment Act to Expedite AI Use in Medical Devices
Senate AI Caucus co-chairs, Senators Martin Heinrich (D-NM) and Mike Rounds (R-SD), recently introduced the Health Tech Investment Act (S. 1399), which would expand access to artificial intelligence (AI) enabled medical devices.
As the use of AI in medical devices becomes more available to detect diseases and inform diagnoses, this bill aims to establish a long-term payment pathway for Food & Drug Administration (FDA) approved, AI-enabled medical imaging devices.
The Health Tech Investment Act would establish consistent and predictable Medicare provider payments by assigning approved AI-enabled medical devices a New Technology Ambulatory Payment Classification (APC) under the Hospital Outpatient Prospective Payment System (OPPS) for at least five years to allow sufficient time to collect data on service delivery and associated costs before establishing a permanent payment code.
Developing a formalized pathway for FDA-cleared medical devices will allow more patients to get the “best, most affordable high-quality care they need when they need it,” said Senator Heinrich in a statement.
To read Senator Heinrich’s announcement of the Health Tech Investment Act, CLICK HERE.
To read more about the bill, CLICK HERE.