Health Policy Report – November 4, 2025

The Network Releases 2025 Capitol Report

The Network is thrilled to announce the publication of the 2025 Capitol Report, now live on LegisLink.com. Over the last year, The Network’s advocacy efforts have emphasized the value of community oncology to policymakers. From driving site-neutral payment reform at the federal level to advancing PBM transparency at the state level, The Network has secured meaningful policy wins nationwide.

Through physician advocacy, we’ve advanced key policy issues impacting community oncology. The Capitol Report highlights those who participated in our annual fly-in and state-level Days at the Capitol, as well as physicians and practice staff who have engaged in media opportunities to amplify our priorities.

The Network also championed several state policies, engaging our community in practice site visits, advocacy events, and notable meetings with lawmakers throughout the year. If you are interested in hosting a site visit for your state representative or state senator, please contact Angela.Storseth@usoncology.com.

To read the 2025 Capitol Report, CLICK HERE.

FCS and CCCB Participate in Roundtable with Senate Health Chair Burton

Florida Cancer Specialists (FCS) and the Cancer Care Centers of Brevard (CCCB) recently participated in a roundtable with Florida Senate Health Policy Chair Colleen Burton and Florida Senate Health Committee Staff.

The conversation centered around cancer research funding opportunities in Florida and how improvements can be made to ensure community practices have opportunities to participate in research. Dr. McDonough, Dr. Patel, and Dr. Hussein of FCS, along with Shelli Johnson of CCCB, educated Chair Burton on becoming involved in the research space, federal guidance and regulations impacting cancer research, and expanding patient access to clinical trials.

CMS Releases CY 2026 Physician Fee Schedule Final Rule

On October 31, the Centers for Medicare & Medicaid Services (CMS) released the Physician Fee Schedule (PFS) Final Rule for 2026. The final rule increases physician reimbursement by 3.77% for qualifying providers in advanced alternative payment models and 3.26% for all other providers.

CMS included an across-the-board -2.6% efficiency adjustment to certain procedural services, an idea that many physician and hospital groups oppose. In a fact sheet, CMS said that the adjustment targets services that are likely to become more efficient over time.

In radiation, after consideration of comments, CMS finalized the proposal to utilize the relationship between the proposed OPPS APC relative weights for APCs 5621, 5622, and 5623 to inform the valuation of PE-only CPT codes 77402, 77407, and 77412, and are refining the utilization crosswalk. The crosswalk is modified to specifically adjust downward the estimated portion that 77412 would be reported compared to 77407 based on commenters’ who represent those who provide care in the non-facility setting. Specifically, CMS is modifying the utilization crosswalk to crosswalk 35 percent of the utilization to CPT code 77412 and 55 percent of the utilization to CPT code 77407.

The agency also finalized a change to the way indirect practice expenses are accounted for, which lowers the amount that facility-based physicians are paid for administrative expenses. The Network has long supported such provisions that better align payment between hospitals and the physician office setting.

“The new Medicare fee schedule delivers a major win for seniors, protects hometown doctors, and safeguards American taxpayers,” Robert F. Kennedy, Jr., Secretary of the Department of Health & Human Services (HHS) said in a statement. “It realigns doctor incentives and helps move our country from a sick-care system to a true health care system.”

To read the final rule, CLICK HERE.

To read a fact sheet, CLICK HERE.

Secretary Kennedy, Commissioner Makary, and Administrator Oz Announce Action on Biosimilar Medications
On October 29, the Food and Drug Administration (FDA) said it will take steps to speed up the process of developing generic versions of complex biological drugs in a bid to increase cheaper competition for expensive medicines and lower drug costs for Americans.

The move could be a blow to pharmaceutical companies, whose most profitable products are often biologicals that treat serious and chronic diseases. During the event, Health and Human Services Secretary Robert F. Kennedy Jr. said the FDA has an “outdated and burdensome approval process that has slowed down the entry of biosimilars.”

The effort is part of the Trump Administration’s action to lower pharmaceutical prices in the United States. As part of this, the White House has proposed “most favored nation” drug pricing models, most recently announcing deals with pharmaceutical companies such as Pfizer, AstraZeneca, and EMD Serono.

The Network will continue to work closely with Administration officials to mitigate the impact of a potential announcement on patients.

To read more, CLICK HERE.

Government Shutdown Enters Fifth Week
As the government shutdown reaches the one-month mark, the stalemate in Congress persists with no immediate deal in sight. The lapse in government funding will soon set an all-time record, and many of the previously delayed impacts of the shutdown are set to take hold beginning November 1.

However, lawmakers from both parties have signaled that they are making some progress towards a pathway out of the government shutdown. The bipartisan discussions are mostly centered around the appropriations process, not the enhanced Affordable Care Act tax credit that is set to expire in December.

To read more, CLICK HERE.

Lawmakers Show Bipartisan Agreement Surrounding 340B Reform
On October 23, the Senate Committee on Health, Education, Labor & Pensions (HELP) held a hearing entitled, “The 340B Program: Examining Its Growth and Impact on Patients.” During the hearing, lawmakers found common ground, agreeing that there is an increased need for transparency in how hospitals use 340B revenue. Members emphasized that the program plays a critical role when functioning as intended, but that its rapid expansion has raised questions about whether program benefits are enriching hospitals, rather than serving communities in need.

Senate HELP Chair, Bill Cassidy, M.D. (R-LA), has been a vocal proponent of transparency in the program, releasing a report earlier this year that outlined potential reforms. A bipartisan working group has also been formed in the Senate to address the need for reform, including Senators Jerry Moran (R-KS), Tammy Baldwin (D-WI), Shelley Moore Capito (R-WV), Tim Kaine (D-VA), Markwayne Mullin (R-OK), and John Hickenlooper (D-CO).

To read more, CLICK HERE.

To read the investigation, CLICK HERE.

Experts Raise Concerns Over Efficacy of Drug Pricing Efforts
The Trump Administration is facing scrutiny from experts amid its continued efforts to bring down the cost of prescription drugs. Health care officials have touted the “most favored nation” drug pricing deals that the Administration has struck as the most effective means to lower drug prices, but health experts have expressed concern that there is little public visibility into these deals. The scope also remains limited, as only a handful of drug companies have agreed to such deals, while thousands more operate in the United States.

Further, the Institute for Clinical and Economic Review (ICER) found that most favored nation pricing policies have operational challenges and expressed support for a value-based model instead.

The criticism comes as drug pricing controls are increasingly popular among Democrats and Republicans alike.

To read more, CLICK HERE.

To read the ICER report, CLICK HERE.

To read more, CLICK HERE.