Health Policy Report – June 10, 2025

Nevada Legislature Passes SB 189
The Nevada Governor recently signed SB 189 into law, which establishes licensure for genetic counselors in the state. Genetic counseling is a growing field, and oncology genetic counselors work with patients with a current diagnosis or family history of cancer to assess the likelihood of genetic risk factors. 

However, Nevada did not previously establish licensure for genetic counselors, presenting challenges for insurance reimbursement. Comprehensive Cancer Centers of Nevada worked closely with lawmakers to generate support for this legislation, making it a centerpiece of their Day at the Capitol in April. During meetings with lawmakers, CCCN’s genetic counselor, Ali Khalif, MS, and Practice President, Dr. Rupesh Parikh highlighted that the lack of licensure for genetic counselors can create barriers for patient access to genetic counseling services.

The Network and Comprehensive Cancer Centers of Nevada celebrate this win for community oncology and look forward to advancing similar legislation in other states.

Senate Considers Reconciliation Bill
The Senate has taken up consideration of the reconciliation package after the House passed the legislation in a narrow vote in May.

The House version of the legislation included significant cuts to Medicaid and an inflation-based update to the Medicare Physician Fee Schedule (MPFS). However, the bill is expected to face hurdles and undergo further changes in the Senate, as key Republicans have expressed concern about its cost. The Congressional Budget Office has estimated that if passed, the reconciliation package will add $2.4 trillion to the deficit.

Senate Majority Leader John Thune (R-SD) has expressed his desire to pass the package ahead of July 4. The Leader has also not closed the door on Medicare provisions, which covers about 20 percent of the U.S. population, mainly seniors. “I think anything we can do that’s waste, fraud and abuse are open to discussions,” Thune said when asked about whether Medicare cuts are on the table. Although Medicare is not likely to be touched beyond the House passed Physician Fee Schedule bump, negotiations are still ongoing.

To read more, CLICK HERE.

National Bureau of Economic Research Releases Working Paper on Medicare Drug Price Negotiation
The National Bureau of Economic Research (NBER) released a new working paper on the impact of the Medicare Drug Price Negotiation Program. The program, created by the Inflation Reduction Act (IRA), capped out-of-pocket (OOP) payments at $2,000 per year, and effective 2026 it will pay lower prices (negotiated by Medicare) for 10 targeted costly and effective drugs.

The paper examines these two provisions and finds that the majority of those using the targeted drugs will experience no change in out-of-pocket costs and for some, an increase in their dollar cost sharing per additional unit of use. The researchers also found that Medicare beneficiaries who see increased spot prices will reduce drug utilization even though they may be financially better off at the end of the year when the Centers for Medicare & Medicaid Services (CMS) negotiates drug prices. 

“Lower negotiated prices lead to savings for both beneficiaries and Medicare, but they are accompanied by an increase in marginal cost-sharing that will discourage access—both to the drugs whose prices were cut and to all other drugs the beneficiary is using,” the authors wrote. 

To read the report, CLICK HERE. 

New Study Shines Light on Use of Step Therapy in MA
The Part B Access for Seniors and Physicians (ASP) Coalition released the results of a new study conducted by Avalere Health examining clinician experiences with step therapy policies in Medicare Advantage (MA) plans. Step therapy, sometimes called “fail first” policies, forces patients to try less expensive medications before being allowed to access their prescribed treatment.

In 2018, the Trump Administration implemented a policy to allow MA plans to implement step therapy for Part B drugs. The study showed that seven years into this policy, 94% of doctors, nurses, and other providers report that step therapy requirements limit their ability to prescribe a Part B drug deemed clinically appropriate for patients. Meanwhile, 74% report that MA step therapy requirements for Part B drugs are not always aligned with clinical guidelines. 56% of providers report that these requirements always or often interfere with physician and patient decision-making.

The study adds to growing momentum amongst physician and patient advocacy groups to urge the Trump Administration to restrict the use of step therapy in MA. 

To read the study, CLICK HERE.

White House Outlines Fiscal 2026 Budget Proposal
The White House has released a detailed budget proposal, giving an in-depth look at what the Trump Administration has planned for the Department of Health and Human Services (HHS). The plan would cut the National Institutes of Health’s budget by $18 million, trim and reshuffle the NIH’s 27 institutions and centers into just eight bodies and consolidate the HHS’ 28 operating divisions into 15.

Most notably, the 340B drug discount program, which has been run under the Health Resources and Service Administration (HRSA) for nearly 30 years, would be moved under the Centers for Medicare & Medicaid Services- (CMS) to streamline processes and take advantage of in-house drug pricing resources and expertise. HHS is also requesting roughly $12.2 million in funding for the 340B drug discount program. These funds will be used to pay for the oversight and auditing of covered entities and participating drug companies, operational improvements, and increased operational efficiencies.

HHS also plans to allot $14 billion to a new agency known as the Administration for a Healthy America (AHA), using “Make America Healthy Again” initiatives that are backed by HHS Secretary RFK Jr.

To read the full budget proposal, CLICK HERE.

To read more about potential changes to 340B, CLICK HERE.

New AMA Report Shows Decline of Physician Practices
The American Medical Association’s (AMA) biennial Physician Practice Benchmark Survey indicates that the share of physicians in private practice continues to decline. This new report details that in 2024, 42.2% of physicians worked in private practices, which is down from 46.7% in 2022 and from 60.1% in 2012. In contrast, the share of physicians working in hospital-owned practices in 2024 increased to more than 34.5%, an increase of 11 percentage points from 23.4% in 2012. 

“Inadequate payment rates, costly resources, and burdensome regulatory and administrative requirements are longstanding and important drivers of this change,” the report reads. When physicians were asked to identify reasons for selling their private practices, the most cited reason was inadequate payment rates. When adjusted for inflation, reimbursements to physician practices have declined by 33% since 2001.

The findings add momentum to the long-standing push for Medicare physician pay, which is currently being considered by Congress in its reconciliation package.

To read more, CLICK HERE.

To read the full report, CLICK HERE.