Health Policy Report – July 8, 2025

Tennessee Cancer Specialists and SCRI Oncology Partners Thank Congresswoman Harshbarger for Introducing HR 2484

Tennessee Cancer Specialists and SCRI Oncology Partners recently released a statement thanking Representative Diane Harshbarger (R-TN) for introducing H.R. 2484, the Seniors’ Access to Critical Medications Act, which recently passed the House Energy & Commerce Committee. If passed, the bill would reinstate the ability for a patient’s family or caregiver to pick up their medications from their independent, community oncology practice’s MID, or allow delivery from the physician’s office for convenience.

“CMS’ policy has created significant access challenges for our patients, forcing them to either drive long distances to receive their medication or use their health plan’s specialty pharmacy or pharmacy benefit manager (PBM) –– options that are often less convenient, impact timeliness of care, and are more costly,” said Dr. Tracy Dobbs of Tennessee Cancer Specialists. “Many of the cancer patients we treat are extremely sick and live in rural areas, meaning they are most negatively impacted by care barriers like this. Therefore, any policy that reduces burdens on them and improves their access to care would be extremely beneficial.”

“We thank Congresswoman Harshbarger for her leadership on the Seniors’ Access to Critical Medications Act, which will help ensure continuity of care for Tennessee cancer patients,” said Dr. David Spigel of SCRI Oncology Partners. 

To read the press release, CLICK HERE.

Ali Khalaf Pens Letter to the Editor on Access to Genetic Counseling in Nevada

Ali Khalaf, genetic counselor at Comprehensive Cancer Centers of Nevada, recently authored a letter to the editor in the Las Vegas Review Journal thanking Governor Lombardo for signing Senate Bill 189 into law, which will strengthen patients’ access to genetic counseling services.

“Until now, Nevada was one of 15 states that did not require licensure for genetic counselors. This had real consequences for patient care, as health insurance companies began citing this lack of licensure as a reason not to reimburse for services. As a result, many of my patients haven’t had access to the full spectrum of genetic counseling services, denying them access to potentially life-saving information and medical support,” he explained.

This legislative session, however, Nevada lawmakers – led by Senator Roberta Lange – passed SB 189, and Governor Lombardo swiftly signed the legislation, which will establish licensure for genetic counselors, help ensure proper reimbursement, and safeguard patient access to critical genetic counseling services.

To read the LTE, CLICK HERE.

The Network Submits Comments on IPAY2028 Guidance

On June 26, The US Oncology Network submitted comments on the Centers for Medicare & Medicaid’s draft guidance on implementation of the Medicare Drug Price Negotiation Program for Initial Price Applicability Year 2028 (IPAY2028) and Manufacturer Effectuation of the Maximum Fair Price in 2026, 2027, and 2028. 

The Network expressed that it remains deeply concerned about the potential unintended consequences that the Inflation Reduction Act (IRA) may have on the viability of physician practices and timely access to care for patients. 

The Network urged CMS to ensure that providers are not forced to shoulder the upfront costs of Medicare Part B drugs, which could accelerate practice closures, drive further consolidation, and restrict patient access to care. Further, The Network noted its support for the Protecting Patient Access to Cancer and Complex Therapies Act, which would help preserve the financial viability of physician practices while still achieving cost savings for Medicare through manufacturer rebates. 

The Network also urged CMS to incorporate Medicare Advantage (MA) data into its review of utilization for drugs payable under Part B and/or covered under Part D. 

To read The Network’s comments, CLICK HERE. 

Congress Passes Reconciliation Package

On July 3, Congress passed its reconciliation package, which includes several health-related provisions and offers modest Medicare reimbursement relief for physicians. H.R.1, the One Big Beautiful Bill Act serves as a vehicle to make permanent the tax rates enacted under the 2017 Tax Cuts and Jobs Act.

The bill includes a 2.5% bump to Medicare payments for physicians in 2026. However, this temporary measure falls short of the more comprehensive inflation-based update that was included in the House-passed version of the bill. Physician groups pushed to restore that provision in the final package, but those efforts were ultimately unsuccessful.

“The modest change in the Medicare physician fee schedule for one year only – 2026 – is welcome, but it does little to address the nearly 3 percent cut in the fee schedule for 2025 and omits a badly needed regular update to the fee schedule to adjust it for a portion of practice cost inflation,” America’s Physician Groups (APG) President and CEO Susan Dentzer said in a statement.

H.R. 1 also includes the Orphan Cures Act, which amends the Inflation Reduction Act (IRA) to ensure that time spent under orphan drug designation does not count toward the timeline for Medicare drug price negotiations if the drug later receives broader approval.

In Medicaid, the bill revises rules on provider taxes beginning in FY 2027, allowing non-expansion states to retain their current rates while requiring expansion states to adhere to a gradually decreasing cap. It also establishes a $50 billion fund over five years to support rural hospitals. Additionally, starting December 31, 2026, states must implement work requirements for certain Medicaid expansion enrollees, with exemptions for vulnerable populations. States will also be required to conduct eligibility redeterminations twice annually. In telehealth, the legislation makes permanent a policy allowing high-deductible health plans to cover virtual visits before deductibles are met—a provision originally introduced during the COVID-19 pandemic.

To read more, CLICK HERE. 

CMS Administrator Oz Highlights Drug Pricing Transparency as Key Priority 

Pharmacy benefit managers (PBMs) are facing renewed scrutiny as the Trump Administration seeks to revive attempts to establish more price transparency in the sector. At an event hosted by Transparency Rx, a group of small pharmacy benefit managers, Dr. Mehmet Oz suggested that the Department of Health & Human Services is considering rulemaking to increase PBM transparency and end the complicated system of drug rebates. 

“If we can do this in an effective way — and we’ll have a rule on this by the end of the year, we hope — then we’ll be able to very forcefully go after folks who are not transparently sharing what it actually costs, or what the transaction prices were, for the drugs that Americans are trying to pick up,” he said.

Lawmakers on both sides of the aisle overwhelmingly support PBM reform, but meaningful reform has yet to pass. The House included some PBM policies in its reconciliation package, but the Senate stripped them out in its version. 

To read more, CLICK HERE. 

To read more, CLICK HERE.

CMMI Model Adds Prior Authorization for Some Services
The Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation (CMMI) recently introduced the Wasteful and Inappropriate Service Reduction (WISeR) Model, a new effort to help patients and providers avoid unnecessary or inappropriate care and safeguard federal taxpayer dollars. WISeR will partner with companies that utilize advanced technologies, such as Artificial Intelligence (AI), to streamline prior authorization decisions and ensure Medicare beneficiaries receive care that is safe, appropriate, and meets proper guidelines. The model excludes inpatient-only services, emergency services, and services that would pose a substantial risk to patients if significantly delayed.

Nearly 25% of healthcare spending goes towards waste and the low-value services being targeted by WISeR often provide little benefit to patients, can result in physical harm and psychological stress, and inflate healthcare spending.

Companies that participate in WISeR will be rewarded based on how well they reduce unnecessary care and improve the speed and quality of the prior authorization process. Healthcare advocacy groups, including the Medical Group Management Association (MGMA), oppose the model, noting that it may add additional administrative hurdles. “Prior authorization continually ranks as the number one administrative burden facing medical groups, and one of the hallmarks of traditional Medicare has been the ability for physicians, not government, to determine what’s clinically appropriate for their patients,” said Anders Gilberg, senior vice president of government affairs of MGMA. “The announcement of this Part B model seems to contradict the administration’s recent commitments to ease the burden of prior authorization.”

To read the CMS press release, CLICK HERE.

To read more, CLICK HERE.

New Report Details Impact of MPFS Cuts
A new issue brief released by the Pacific Research Institute’s Center for Medical Economics and Innovation warns of the devastating effects that underpayment to doctors has on America’s healthcare system. 

Written by PRI senior fellow and CMEI director Dr. Wayne Winegarden, the brief finds that Medicare reimbursement rates are well below market value and have failed to keep up with inflation or the rising costs of running a medical practice. When adjusted for inflation, physician payment has declined by nearly 33%.

“Medicare has effectively imposed income controls on doctors,” said Winegarden. “These unsustainably low reimbursement rates are creating a cascade of negative outcomes—discouraging private practice, worsening the doctor shortage, and ultimately threatening the quality of care patients receive.”

Proposed short-term fixes include an inflation adjustment for physician payments, site neutral payment, reform and including value-based care initiatives, and a direct payment model that provides seniors with health savings accounts. 

To read the brief, CLICK HERE.

To read more about physician payment, CLICK HERE.

Federal Court Rules Against J&J’s Proposed 340B Drug Rebate Model 

On June 27, a judge for the U.S. District Court for the District of Columbia ruled against Johnson & Johnson (J&J) in their lawsuit challenging the government’s authority to reject J&J’s proposed 340B rebate model. 

The decision marks the second time in the last few months that a federal court sided with the U.S. Health Resources and Services Administration (HRSA), which last year pushed back against plans by several drugmakers to alter their payment models for the 340B Drug Discount Program. 

The judge ruled that HRSA did not violate the law when it required J&J to seek approval before offering rebates to hospitals and clinics that participate in a drug discount program. “In sum, based on the plain and unambiguous language of the 340B statute, and supported by its purpose and history, HRSA has the authority to ‘provide’ for discounts, rebates, or both,” Judge Rudolph Contreras wrote. “This conclusion defeats J&J’s claim that HRSA lacked the authority to require prior approval of J&J’s rebate model.”

To read the opinion, CLICK HERE.