March 4, 2025
Health Policy Report – March 4, 2025
Texas Oncology Holds Advocacy Day at the Capitol
On February 19th, Texas Oncology, a leader in community-based cancer care, gathered at the Texas State Capitol for their Advocacy Day at the State Capitol. Ninety physician leaders and advocates met with over 50 legislators to promote accessible, high-quality, affordable cancer care, underscoring Texas Oncology’s commitment to patient care beyond their 300+ locations in Texas and southeastern Oklahoma.
During Advocacy Day, Texas Oncology advocated for legislative priorities to protect patients and enhance cancer care. These included fighting insurance barriers that delay treatments, promoting telemedicine and cancer screenings for timely care, and supporting initiatives that address cancer’s physical and emotional impacts.
Additionally, Dr. Debra Patt was honored with the first “Physician Advocacy Champion” award from The US Oncology Network and a resolution from State Representative Tom Oliverson, MD, for her outstanding contributions to community oncology advocacy. Her dedication to patient care and advocacy embodies the spirit of the award.
Texas Oncology’s Advocacy Day was a powerful reminder of the impact of collective action in shaping healthcare policies for cancer patients. Thanks to all participants, Texas Oncology remains a leading voice for cancer patients in Texas and beyond.
Thank you to The US Oncology Network advocates and Texas Oncology physicians, pharmacists, and leaders who traveled to Austin, Texas and helped make our Day at the Texas Capitol a success. If you are interested in hosting a site visit for your state representative or state senator, please contact Angela.Storseth@usoncology.com.
Dr. Les Busby and Dr. Scott Herbert Pen Op-Eds on Transparency in the 340B Program
Dr. Les Busby of Rocky Mountain Cancer Cancers (RMCC) and Dr. Scott Herbert of Nexus Health both recently penned op-eds urging lawmakers to prioritize transparency in the 340B Drug Pricing Program.
In a recent op-ed in Colorado Politics, Dr. Les Busby described how the 340B program is failing to meet its intended purpose of helping safety-net providers expand care to low-income patients. Dr. Busby described that though hospitals participating in the 340B program are using drug discounts to expand their charity care offerings, many are instead pocketing the drug discounts to generate additional revenue.
He went on to describe how these benefits give hospital systems leverage over independent providers. “It’s simple math the program gives hospitals a competitive advantage over independent practices. The 340B program has spurred increased consolidation as hospitals gobble up independent practices that cannot afford to compete. According to one study, hospital acquisitions of independent oncology practices increased by 9.8% from 2018 to 2020, driven largely by the 340B program’s financial incentives,” he wrote.
Dr. Busby concluded by calling on Colorado lawmakers to evaluate how 340B drug discounts are being used, noting lawmakers’ interest in transparency efforts during Rocky Mountain Cancer Centers’ recent Day at the Colorado Capitol.
Similarly, in the Santa Fe New Mexican, Dr. Scott Herbert noted that hospitals receive significant benefits – including 340B discounts, higher reimbursements, and facility fees – that independent practices don’t, creating an unbalanced healthcare system.
Dr. Herbert called on independent practices and hospitals to work together to overcome this imbalance and protect a variety of care options. “Our community stays healthy by getting care in the most cost-effective setting and working together,” he concluded.
To read Dr. Busby’s op-ed, CLICK HERE.
To read Dr. Herbert’s op-ed, CLICK HERE.
Stakeholders Send Letter to Hill on Physician Payment
Over 100 advocacy groups signed on to a letter urging Congress to advance H.R. 879, the Medicare Patient Access and Practice Stabilization Act, which would reverse the 2.8% reduction in the Medicare Physician Fee Schedule (MPFS) that went into effect on January 1 and provide a 2% payment update.
In the letter, the groups highlighted that this year marks the fifth consecutive year of cuts to physician pay, going on to note that the MPFS is the only major provider fee schedule without an automatic inflationary update.
“The ongoing downward reimbursement spiral is also contributing to consolidation in the healthcare system, as more clinicians are no longer able to sustain their practices and are forced to seek alternative business models, such as hospital employment, private equity and other alternatives. Finally, these cuts threaten the ability of our members — which are employers and small business owners — to serve as economic engines of our local communities,” the letter read.
The groups concluded by calling on lawmakers to pass the Medicare Patient Access and Practice Stabilization Act in the March budget package. “We understand that Congress faces many complex issues, competing priorities, and shrinking legislative calendars. However, our members — and, more importantly, our patients — cannot wait any longer,” they concluded.
To read the letter, CLICK HERE.
To urge your Member of Congress to support H.R. 879, CLICK HERE.
House Energy & Commerce Health Subcommittee Holds Hearing on PBM Practices
On February 26, the House Energy & Commerce Committee’s Health Subcommittee held a hearing on opportunities for pharmacy benefit manager (PBM) reform, entitled “How Reining in Pharmacy Benefit Managers Will Drive Competition and Lower Costs for Patients.”
During the hearing, lawmakers pledged to relaunch a push for transparency measures and issue a ban on spread pricing, or when a PBM charges more to an insurer than it pays a pharmacy for the prescription. PBM reform measures nearly made their way into law in a government funding package late last year, before being pulled in favor of a “clean” continuing resolution that was largely stripped of healthcare provisions.
“I can tell you it is a priority of mine to ensure these commonsense and bipartisan policies become law,” said Brett Guthrie (R-KY), Chairman of the Energy and Commerce Committee.
Congress is currently working on another spending bill to fund federal operations for the remainder of fiscal year 2025, while Republicans are moving forward with spending reduction measures. Either could be a vehicle for PBM legislation, though lawmakers continue to discuss the best path forward for such measures.
To watch the hearing, CLICK HERE.
To read more, CLICK HERE.
House Passes Budget Resolution Framework
On February 25, the House of Representatives narrowly passed a multi-trillion-dollar budget resolution in a 217-215 vote.
The bill contains $2 trillion in spending cuts overall and calls for the Energy & Commerce Committee to find $880 billion in savings and spending reductions from programs under its jurisdiction. President Trump has repeatedly stated he does not want cuts to Medicare, setting the stage for potential reforms to Medicaid that could generate significant cost savings.
Ahead of the vote, many patient advocacy groups released statements urging House members to oppose cuts to Medicaid. “ACS CAN opposes cuts that will increase the number of uninsured nationwide by severing the lifeline Medicaid provides for cancer patients and those at risk for cancer. It is imperative for cancer patients and millions more at risk that this valuable health insurance program be protected,” said Lisa Lacasse, President of the American Cancer Society Cancer Action Network (ACS CAN).
The bill’s passage in the House paves the way for a reconciliation bill that lets Republicans bypass a filibuster in the Senate and push through a spending bill.
To read more, CLICK HERE.
Department of Health & Human Services (HHS) Impacted by Federal Workforce Cuts
As the Trump Administration seeks to reduce the size of the federal workforce, the Department of Health and Human Services (HHS) has seen significant job cuts across some of its biggest agencies, including the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC).
The Trump Administration ordered that nearly all 5,200 HHS probationary employees – those with less than one or two years of experience in their current positions – be eliminated. Several of the affected employees include those who conduct Affordable Care Act (ACA) exchange oversights and evaluate medical device safety.
While some employees – including those at the Indian Health Service – were recently notified that their termination had been rescinded, HHS was instructed to implement another round of layoffs.
As the situation evolves, agencies have been instructed to continue evaluating probationary employees, remove underperforming employees, and adhere to data-driven efficiency plans.
To read more, CLICK HERE.
AMA Releases New Survey on Prior Authorization
A new survey from the American Medical Association (AMA) details how physicians and patients alike continue to be heavily burdened by prior authorization. According to the study, nearly three in five physicians (61%) are concerned that health plans’ use of artificial intelligence is increasing prior authorization denials.
AI-generated prior authorization decisions are made with little or no human review and in some cases deny treatment at rates sixteen times more than is typical.
“Using AI-enabled tools to automatically deny more and more needed care is not the reform of prior authorization physicians and patients are calling for,” said AMA President Bruce A. Scott, M.D. in a statement. “Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care. Medical decisions must be made by physicians and their patients without interference from unregulated and unsupervised AI technology.”
The study also found:
– More than one in four physicians (29%) reported that prior authorization has led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment, or death.
– More than nine in 10 physicians (93%) reported that prior authorization delays access to necessary care.
– Nearly nine in 10 physicians (89%) reported that prior authorization somewhat or significantly increases physician burnout.
The findings add urgency to a growing push for policymakers to address prior authorization and ensure that physicians can focus on patient care, rather than administrative burdens.
To read the study, CLICK HERE.
To read the AMA’s statement, CLICK HERE.