Health Policy Report – June 24, 2025

Dr. John Schuler Pens Letter to the Editor on SB 125 in Oregon

Following his testimony to the Oregon Senate Committee on Finance and Revenue, Dr. John Schuler, a radiation oncologist at Compass Oncology, penned a letter to the editor (LTE) in the Southwest Connection in support of SB 125. If passed, SB 125 would exempt medical providers caring for publicly insured patients from the state’s Corporate Activity Tax (CAT).

In the letter, Dr. John Schuler described how the CAT negatively impacts independent medical providers. “While other businesses subject to the CAT have increased prices to cover their tax burden, independent medical practices can’t — and won’t — pass along higher costs to patients for needed medical care. Since the buck stops with us, we’re forced to absorb the cost of this tax.”

Dr. Schuler went on to explain that the CAT limits practices’ ability to reinvest in patient care or hire new staff. Moreover, by threatening independent practices’ financial viability, the CAT furthers healthcare consolidation. 

Dr. Schuler explained that SB 125 offers a common sense solution to protect patients’ access to care. “I urge state lawmakers to support this bill, reverse the unintended consequences of the CAT, and protect access to high-quality, community-based care,” he concluded.

To read the LTE, CLICK HERE. 

The Network Submits Comments to CMS on Health Ecosystem Request for Information

On June 16, The Network submitted comments to the Centers for Medicare & Medicaid Services (CMS) on its Request for Information (RFI) on the Health Technology Ecosystem.

In its comments, The Network expressed its belief that any changes to digital tools should reduce administrative burden for providers and promote interoperability. Further, The Network noted the importance of removing unnecessary regulatory barriers that hinder the sharing of electronic protected health information (ePHI) among all entities involved in care coordination.

In the long term, The Network encouraged the agency to establish a unique patient identifier and transition to a national registry model—developed in partnership with the CDC—for capturing cancer, immunization, syndromic surveillance, and electronic case reporting (eCR) data.

“The Network believes that patient-centered healthcare interoperability can transform care delivery, improve outcomes for all, and empower patients to be active individuals in their healthcare journey. Our recommendations are common-sense outgrowths of the Department’s completed and continuing efforts to promote interoperability, improve care coordination, and increase transparency in an otherwise siloed and opaque system that has stood too long in the way of value-based care,” The Network concluded. 

To read The Network’s comments, CLICK HERE.

Senate Finance Committee Releases Reconciliation Text

On June 16, the Senate Finance Committee released its long-awaited reconciliation text. The bill includes steep cuts to Medicaid, including work requirements and an aggressive stance on provider taxes in Medicaid. 

Notably, the final text omitted a House-backed provision that would have provided physicians with partial payment relief by tying updates to the Medicare Physician Fee Schedule (PFS) conversion factor to 75% of the Medicare Economic Index (MEI) in 2026, and just 10% of the MEI in 2027 and beyond. While many stakeholders and advocates viewed this measure as a meaningful first step toward long-term payment reform, some physician groups expressed disappointment with what they considered an inadequate solution. Physician advocates continue to push for the inclusion of PFS relief in a final legislative package, and its exclusion from the current version is seen as a significant setback.

The legislation also left out a provision that would have expanded the number of orphan drugs exempt from Medicare drug price negotiations. However, the Senate Finance Committee’s bill retains several key reforms, including a ban on spread pricing by pharmacy benefit managers (PBMs) in Medicaid, the delinking of PBM compensation from drug list prices, and the implementation of a 100% pass-through pricing model. GOP leaders are aiming to push the bill through the Senate by July 4. 

To read more, CLICK HERE.

AHIP Releases Statement on Prior Authorization

On June 23, more than 50 major health insurance companies announced a commitment to “streamline, simplify, and reduce prior authorization.” The insurers outlined six key reforms designed to cut administrative red tape, speed up care decisions, and improve transparency for both patients and providers.

These reforms include standardizing electronic prior authorization processes, narrowing the range of services subject to prior authorization, and supporting patients in avoiding care delays and maintaining continuity during insurance transitions. Further, health plans have pledged to provide clear explanations on prior authorization determinations, implement real-time responses through electronic prior authorization, and ensure medical review of requests that are not approved.

The voluntary changes are expected to take effect by the end of the year. Federal officials, including Department of Health and Human Services (HHS) Secretary Robert Kennedy, Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz welcomed the changes but noted that they are prepared to implement new regulations if insurers don’t abide by the agreement.

To read more, CLICK HERE.

PBMs Push Back on Growing State Regulations

As federal lawmakers weigh limited federal reforms to PBMs, states have taken the lead in passing legislation to regulate drug middlemen. This year, all fifty states had bills that would impact PBMs or drug benefits, marking growing scrutiny of their role in the healthcare marketplace.

Recently, Arkansas made headlines for a first-in-the-nation law that prohibits PBMs from simultaneously owning pharmacies. “Pharmacy benefit managers can still operate in our state; they just can’t continue to mistreat patients and box out other pharmacies,” Arkansas Governor Sarah Huckabee Sanders said in a statement. 

In response, CVS Health and Cigna, which owns Express Scripts, filed lawsuits to stop Arkansas from enforcing the law. CVS Health says it will have to close 23 pharmacies in Arkansas under the law, which is effective on January 1. 

To read a statement from Governor Sanders, CLICK HERE.

To read more, CLICK HERE.

Part B ASP Coalition Holds Webinar on Impact of IRA on Part B Drugs

On June 11, the Part B Access for Seniors and Physicians (ASP) Coalition held a webinar overviewing a new report from the Milliman Institute, which showed the potential impact of the Inflation Reduction Act (IRA) and its changes to Medicare Part B on physician reimbursement and patient access to care.

The report, released on May 9, reveals that the Inflation Reduction Act’s net cost to oncology providers would be $26,927 over ten years, the highest of the specialties examined. 

During the webinar, panelists went on to discuss the need for Congress to re-introduce the Protecting Patient Access to Cancer and Complex Therapies Act (PACTA) which would amend the IRA to keep physician reimbursement ASP-based and instead create an additional rebate paid by manufacturers.

Under the proposal, physician practices would continue to receive reimbursement at the current ASP+6% rate, while drug manufacturers would provide a direct rebate to the federal government for the difference between that rate and MFP. Patients would benefit from lower out-of-pocket costs, as their coinsurance would be based on the reduced MFP.

To read the study, CLICK HERE.