Health Policy Report – May 28, 2025

Maryland Oncology Hematology Attends Bill Signing Ceremony at Maryland Capitol

On May 20, The Network’s government relations team and Maryland Oncology Hematology (MOH) attended a bill signing ceremony at the Maryland State Capitol. During the ceremony, Maryland Governor Wes Moore signed HB 1243 and SB 975 into law, which will permit cancer patients to access specialty drugs from community oncology practices and limit interference from pharmacy benefit managers (PBMs). 

The bill signing culminates years of advocacy from physicians at MOH, who have worked closely with The Network’s government relations team to hold meetings with lawmakers and provide testimony in front of key committees. This spring, Dr. Kash Firozvi testified in support of the bill, describing the benefits of medically integrated dispensing for patients, including enhanced communication between patient and provider, improved adherence, reduced drug waste, and lower costs. “Patients deserve the freedom to choose their providers and make decisions that align with their best interests,” Dr. Firozvi said. 

The Network celebrates the enactment of this legislation and looks forward to advancing similar legislation nationwide. 

To read more, CLICK HERE.

House of Representatives Passes Reconciliation Legislation

Early on May 22, the House of Representatives passed its version of the budget reconciliation bill after Republicans made a last-minute slate of changes. The narrow 215–214 vote advances Medicaid work requirements, introduces transparency measures for pharmacy benefit managers (PBMs), and, notably, implements an inflation-based update to physician payments under the Medicare Physician Fee Schedule (MPFS).

The bill would ban “spread pricing,” where PBMs negotiate a better price for a drug and keep some of the savings, instead of passing them along to pharmacies and beneficiaries. Further, PBMs would have to provide detailed information to drug plan sponsors and the Department of Health and Human Services (HHS) about pricing and discounts, as well as details on how many and which drugs are dispensed.

Also most notably, for the first time, Medicare pay rates for doctors would also increase based on inflation. Currently, doctors do not receive pay increases tied to inflation. The bill would increase pay by 75% of the rate of Medical Economic Inflation (MEI) in 2026 and pay rates would increase by 10% of MEI in subsequent years for a ten-year period. The Centers for Medicare and Medicaid (CMS) will release their proposed rule for the Medicare Physician Fee Schedule later this summer.

The legislation now heads to the Senate, where changes are anticipated over the coming weeks. 

To read more, CLICK HERE. 

To read more about the inflation-based pay update, CLICK HERE. 

Dr. Casey Means Nominated for Surgeon General

The Trump Administration has announced that Casey Means, MD will be nominated for Surgeon General, revoking the previous nomination of Dr. Janette Nesheiwat, a former Fox News contributor, for the position. President Trump made the announcement on May 7, just one day before the Senate health committee was set to hold a confirmation hearing on Nesheiwat’s appointment. 

With close ties to Robert F. Kennedy Jr., the Secretary of the Department of Health & Human Services (HHS), Dr. Casey Means has emerged as a leader of the Make America Healthy Again (MAHA) movement. In public remarks and writings, Casey Means has linked rising rates of chronic disease to environmental chemicals, pharmaceuticals, and lifestyle choices. 

Dr. Means’ confirmation date has yet to be announced. 

To read more, CLICK HERE. 

Seniors’ Timely Access to Care Act Reintroduced in House and Senate

The Seniors’ Timely Access to Care Act, a bill that seeks to reform prior authorization, has been reintroduced in the House and Senate. The bill is co-sponsored by Senators Roger Marshall (R-KS) and Mark Warner (D-VA) in the Senate, with Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, MD (D-CA), and John Joyce, MD (R-PA) co-sponsoring the House version. 

If passed, the bill would establish an electronic prior authorization process for Medicare Advantage (MA) plans, increase transparency around MA prior authorization requirements, and clarify the Department of Health and Human Services (HHS) authority to establish timeframes for e-prior authorization requests, among other measures. 

“Prior authorization is the number one administrative burden facing physicians today across all specialties,” Senator Marshall said in a press release. “As a physician, I understand the frustration this arbitrary process is causing health care practices across the country and the headaches it creates for our nurses.”

Many industry groups, including the American Medical Association (AMA), American Hospital Association (AHA), and Better Medicare Alliance, support the bill. The US Oncology Network has also signed on in support and looks forward to working with lawmakers to advance these reforms.

To learn more, CLICK HERE. 

To read Senator Warner and Marshall’s press release, CLICK HERE. 

To read Representative DelBene’s press release, CLICK HERE. 

District Court Provides Guidance on 340B Rebate Model

In a recent ruling, the District of Columbia District Court ruled against drugmakers Eli Lilly, Bristol Myers Squibb, Sanofi, and Novartis, ruling that they must provide up-front discounts to hospitals participating in the federal 340B Drug Pricing Program. 

The drugmakers sued the government after the Health Resources and Services Administration (HRSA) blocked their plans to pay 340B hospitals rebates, rather than providing discounts at the point of sale. Drugmakers have argued that a rebate model would allow them to bring greater accountability to the program, which seeks to offer lower drug prices to safety net providers. 

“The Court finds that HRSA did not act contrary to law by requiring the plaintiffs to obtain approval before implementing their proposed rebate models,” Judge Dabney Friedrich wrote in the decision. 

To read more, CLICK HERE. 

Conservative Groups Urge Congress to Pass Site-Neutral Payments

A group of more than 30 conservative groups sent a letter to congressional leaders, urging them to use the reconciliation process to impose new Medicare site-neutral policies, arguing the current pay structure incentivizes healthcare consolidation and higher government spending.

“Site neutrality corrects a decades-long oversight in Medicare’s payment system — by mandating the same price for the same treatment, regardless of where it is performed,” the letter read. “Not only are these common-sense reforms, but they have also been a part of public policy discussions for more than a decade and garnered bipartisan support in recent years.”

In a separate white paper, the ERISA Industry Committee (ERIC), which represents employers that offer health benefits, also outlined the value of site-neutral payment reform, which would help level the playing field between hospitals and independent physicians. 

Though site-neutral payment reform was not included in the reconciliation package, experts expect that the policy may resurface in a spending bill or potentially a stand-alone package later this year. 

To read the letter, CLICK HERE. 

To read ERIC’s white paper, CLICK HERE.