Health Policy Report – August 19, 2025

Compass Oncology Hosts Representative Andrea Salinas for Site Visit
On Tuesday, August 2, Compass Oncology hosted Representative Andrea Salinas (D-OR) for a tour of their West Cancer Clinic in Tigard, Oregon. Through the tour, led by Dr. Schuler, the Compass Oncology team emphasized policy challenges facing independent cancer care providers, including the importance of allowing patients to receive their oral oncolytics directly from their care team—whether by mail or through a trusted caregiver pickup—rather than through complex pharmacy benefit manager (PBM) channels. 

The team also addressed how the Inflation Reduction Act is unintentionally catching providers in the middle of the drug pricing negotiation process, the need for a sustainable reimbursement structure for radiation oncology, and the importance of advancing site-neutral payment reforms. 

Congresswoman Salinas’ service on the House Agriculture Committee and the House Science, Space, and Technology Committee gives her a unique perspective on the broader challenges facing communities that Compass Oncology serves. The US Oncology Network and Compass Oncology thanked Congresswoman Salinas for her dedicated public service, and we look forward to continuing to show federal lawmakers the importance of local cancer care. 

If your practice is interested in hosting a site visit, please contact Angela Storseth at angela.storseth@usoncology.com.

New AMA Report Shines Light on PBM Marketplace

The American Medical Association recently released its 2025 report on the state of competition and consolidation within pharmacy benefit manager (PBM) markets.

The report, “Competition in PBM Markets and Vertical Integration of Insurers with PBMs,” found that the overwhelming majority of PBM markets are highly concentrated. Collectively, the four largest PBMs in the United States captured 67% of the market in 2023, with OptumRx alone accounting for the biggest portion at 22.2% of the market. Underscoring the extent of vertical integration throughout the market, 9 of the 10 largest PBMs share ownership with health insurers.

The report concluded that when some insurers and affiliated PBMs make acquisitions in one market, rival firms feel compelled to do the same, leading to even more consolidation. “Low competition may lead to higher prices paid by insurers for PBM services, higher insurance premiums, PBMs not fully passing rebates through, and lower reimbursement to pharmacies. Moreover, given extensive vertical integration of insurers and PBMs, nonaffiliated insurers may be losing access to PBMs,” the report concluded. 

To read the full report, CLICK HERE.

To read more about the analysis, CLICK HERE and HERE.

Industry Reacts to HRSA 340B Rebate Model

The Health Resources and Services Administration (HRSA) recently announced a new 340B rebate model, which would require covered entities to purchase 340B drugs at their wholesale cost and then apply for after-the-fact rebates after dispensing products to an eligible patient. The pilot program, which is slated to begin on January 1, 2026, would only cover the 10 drug products included on the Centers for Medicare and Medicaid Services (CMS) Medicare Drug Price Negotiation Selected Drug List.

In response, the American Hospital Association (AHA), along with several other groups representing 340B hospitals urged HRSA to extend the timeline for stakeholder comments and agency consideration. 

“With the fundamental changes a rebate model will impose on all 340B stakeholders, it is impossible for the agency to meaningfully consider, in just seven days, all the feedback it will surely receive,” the groups wrote. “Moreover, drug companies have spent years developing and preparing for a rebate model, but the agency’s current timeline would give 340B hospitals far less time to prepare.”

To read more about HRSA’s 340B rebate model, CLICK HERE.

To read AHA’s press release, CLICK HERE.

Paragon Health Previews Upcoming Legislative Priorities, Including Site Neutral Payment Reform

As Congress gears up to return to session in September, the Paragon Health Institute, a conservative health policy think tank, is outlining its legislative priorities for the remainder of 2025. 

The Paragon Institute was influential in shaping the reconciliation package passed this summer, which includes work requirements for Medicaid eligibility. Now, the think tank has pivoted to focus on implementation of work requirements at the state level. 

Further, however, Paragon Health is focused on advancing site neutral payment reform, which was excluded from the reconciliation package but has gained momentum amongst policymakers over the last few years. In July, the Centers for Medicare & Medicaid Services (CMS) demonstrated a growing commitment to site neutral policies in the Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (HOPPS) final rules. According to Ryan Long, director of congressional relations and senior health fellow at Paragon, site neutral payment reforms will help “inject greater competition” into healthcare. 

To read more, CLICK HERE. 

New Study Shows Reimbursement Fails to Keep Pace with Increases in Physician Productivity

A new report from the consultant group Kaufman Hall shows that primary care physicians and specialists are delivering more services since the pandemic but continue to encounter stagnant reimbursement and rising costs. According to the report, the median payment for the amount and type of treatment clinicians provide declined 7% between the second quarters of 2023 and 2025. Over that same span, the median expense per physician and advanced practice practitioner rose 7%.

During the same period, the amount of net revenue per unit of work, or how much a physician generates for the volume of work they put in, fell 7%. In other words, employed providers are having to complete more work to bring in the same amount of money. 

“Revenue has increased because physicians and providers are working more, but the data also show that reimbursement is not keeping pace,” Matthew Bates, managing director and physician enterprise service line leader at Kaufman Hall, said in a release. “In the coming months if more patients lose insurance coverage, this trend will likely get worse.”

These disturbing trends help explain why many doctors have opted to sell their practices to a health system or private equity firm, a trend that has accelerated healthcare consolidation and has raised prices overall.

To read the report, CLICK HERE.