February 5, 2025
Health Policy Report – February 5, 2025
Texas Attorney General Issues Opinion Protecting Patients from Deceptive PBM Business Practices
On February 5, Texas Attorney General (AG) Ken Paxton issued an opinion affirming that two key bills to reform pharmacy benefit manager (PBM) practices, HB 1919 and HB 1763, are enforceable with respect to ERISA plans and out-of-state health plans operating in Texas.
HB 1919, championed by Representative Cody Harris, targets practices where PBMs steer pharmacy patients toward PBM-owned pharmacies. HB 1763 prohibits PBMs from charging retroactive fees and bars restrictions on pharmacy delivery or mailing of medications. It also prohibits PBMs from reimbursing affiliated pharmacies more than they pay non-affiliated pharmacies for the same drug.
Following the enactment of both bills, State Senator Charles Schwertner and the Texas Senate Business and Commerce Committee requested the opinion of Attorney General Paxton to clarify how the legislation could be enforced. By effectively stating that there are no barriers to the enforcement of these two laws, the opinion marks a significant win for community oncology. The Network looks forward to continuing to work with policymakers to protect patients from deceptive PBM business practices.
To read the opinion, CLICK HERE.
Senate Holds Hearing for RFK Jr., Nominee for HHS Secretary
On January 29 and 30, Robert F. Kennedy Jr., nominee for Secretary of the Department of Health & Human Services (HHS), appeared before the Senate Finance Committee and Senate Health, Education, Labor, and Pensions (HELP) Committee for nomination hearings.
Before the Senate Finance Committee, RFK Jr. told members that pharmacy benefit manager (PBM) reform is a must for the Trump administration, noting that he will support Congress as it continues its crackdown on PBMs. “I support the efforts of this committee to come up with bipartisan legislation. President Trump wants to get the excess profits away from the PBMs and send it back to primary care, to patients in this country,” he said.
Additionally, RFK Jr. referenced the Trump administration’s support for the Medicare drug price negotiation program established by the Inflation Reduction Act (IRA). “President Trump was very aggressive during his first term about negotiating drug prices,” Kennedy said, noting that he discussed lowering drug prices for seniors with the President.
Kennedy’s statement came as the Centers for Medicare & Medicaid Services (CMS) announced it will continue with negotiations on 15 drugs under the next round, as planned, and explore ways to improve future negotiations.
“As the second cycle begins under the Trump Administration, CMS is committed to incorporating lessons learned to date from the program and to considering opportunities to bring greater transparency in the Negotiation Program,” the statement says. “CMS intends to provide opportunities for stakeholders to provide specific ideas to improve the Negotiation Program, consistent with the goals of achieving greater value for beneficiaries and taxpayers and continuing to foster innovation.”
On Tuesday, February 4, the Senate Committee on Finance held a 30-minute-long Executive Session to consider RFK’s nomination. Sen. Bill Cassidy (R-LA) joined the rest of the committee in voting along party lines voting favorably to send the nomination to the Senate floor with a vote of 14-13. RFK’s nomination is now slated to head to the Senate floor for final approval.
To watch the Senate Finance Committee hearing, CLICK HERE.
To watch the HELP Committee hearing, CLICK HERE.
Representatives Greg Murphy (R-NC) and Jimmy Panetta (D-CA) Introduce the Medicare Patient Access and Practice Stabilization Act
On January 31, a group of lawmakers, led by Representatives Greg Murphy, MD (R-NC) and Jimmy Panetta (D-CA), unveiled a bipartisan bill, H.R. 879 the Medicare Patient Access and Stabilization Act, which would increase Medicare payments by an additional 6.62% to fully offset the reimbursement cut that went into effect on January 1, 2025.
The bill would propose a prospective pay fix starting April 1 to increase Medicare payments by an additional 6.62% meaning that it would leave all Medicare claims previously processed unchanged and adjust all future Medicare claims in 2025.
Lawmakers introduced similar legislation last October, which was originally included in the end-of-year funding package but was removed at the last hour. This reignited push follows years of advocacy to reform the Medicare physician fee schedule, which many view as putting increasing strain on physician practices and patient access to quality care.
“Physicians in America are facing unprecedented financial viability challenges due to continued Medicare cuts. Access to affordable and quality health care for millions of seniors is in severe jeopardy,” said Congressman Greg Murphy, M.D. “Doctors see Medicare patients out of compassion, not for financial gain. The cost of caring for a Medicare patient far outpaces the reimbursement that physicians receive for seeing them.”
To urge your Member of Congress to pass H.R. 879, CLICK HERE.
To read the bill, CLICK HERE.
To reach the press release, CLICK HERE.
President Trump Reverses Biden-Era Healthcare Policies Through Executive Orders, Imposes Restrictions on HHS, NIH
After taking office, President Trump has signed a series of executive orders, including a sweeping order aimed in part at reversing several Biden administration initiatives on healthcare.
The executive order overturned a policy that extended the Affordable Care Act’s open enrollment period for an additional 12 weeks in 36 states, giving uninsured adults more time to sign up. Additionally, President Trump rescinded an order to strengthen Medicaid by providing more outreach funding to states and reversed the $2,000 annual out-of-pocket cap on prescription drugs established under the Biden administration.
Soon after, the Trump administration paused external communications at the US Department of Health and Human Services (HHS). As a result, the National Institutes of Health (NIH) canceled meetings, including grant review panels on cancer research, sparking concern from oncologists.
On January 26, the Trump administration paused all federal loans and grants. The order was soon overturned by a federal judge and was later rescinded by the White House.
To read more about the executive orders, CLICK HERE.
To read more about NIH meeting cancellations, CLICK HERE.
To read more about the freeze on federal loans and grants, CLICK HERE.
Study Finds that Hospital, PE-Affiliated Primary Care Doctors Charge More than Independent Physicians
In a new study, Brown University School of Public Health researchers analyzed nearly 226.6 million prices from about 198,000 primary care physician evaluation and management office (E&M) charges and changes in physician ownership of practices. According to the report, an increasing share of primary care physicians are affiliated with hospitals and private equity (PE) firms, which yield higher negotiated prices for commercial office visit spending compared to the same services at independent practices.
The report indicates that office visits were nearly 11% higher and 8% higher at hospital-affiliated and PE-affiliated PCPs, respectively, than at their independent counterparts. The researchers estimated that commercial office visit spending within the sample neared $10.9 billion but would decrease by about 15% ($1.5 billion) if those same visits were set at mean independent office PCP prices.
The report comes as consolidation and corporate medicine continue to dominate discussions amongst policymakers, building momentum for transparency legislation in the 119th Congress.
To read the study, CLICK HERE.
To read more, CLICK HERE.
PBM Transparency Remains Top Priority for Senate HELP Committee
The Senate Health, Education, Labor, and Pensions (HELP) Committee emphasized its commitment to advancing legislation for PBM reform and affordable drug costs during the first meeting of the 119th Congress.
In Committee Chair Senator Bill Cassidy’s (R-LA) opening remarks, he addressed bipartisan PBM reform and drug pricing efforts as a key priority. Senator Cassidy referenced the committee’s previous work in reforming misaligned PBM incentives and providing drug discounts to patients through the PBM Reform Act, which failed to pass in the last Congress.
At an event for the American Enterprise Institute (AEI), a staffer on the House Ways & Means Committee noted that there’s plenty of political will to reform PBMs in the 119th Congress. “I do think there are disparate ideas across Congress as to how much intervention within the PBM market is appropriate. What you’ve seen come through Congress in the final package is probably the litmus test, or maximum, of what is feasible for that type of reform.”
To watch Senator Cassidy’s HELP committee remarks, CLICK HERE.
To read more about potential action on PBMs, CLICK HERE.