Insights: Healthcare

Healthcare Extenders/Reforms (MA, Site Neutral, PBMs, Extenders)

Outside of the ACA eAPTCs, lawmakers are also intensifying their work around other unresolved healthcare issues – including, for example, Medicare/Medicaid extenders, pharmacy benefit manager (PBM) reforms, Medicare Advantage (MA) upcoding reforms, and Medicare fee-for-service (FFS) site neutral payment reforms.

Affordable Care Act (Enhanced Subsidies)

With Congress returning from August recess, lawmaker focus on the end-of-year expiration of the ACA enhanced subsidies (eAPTCs) is intensifying.

Drug Pricing/Most-Favored Nation (MFN)

Drugmaker Eli Lilly has indicated it will attempt to increase the price of its medicines in Europe and other developed nations to effectuate price reductions in the U.S.

End-of-Year Healthcare Legislation (ACA, MA, Site Neutral, PBMs, Extenders)

Leadership of Paragon Health Institute (an influential conservative healthcare think-tank founded by former Trump administration officials) recently met with the Republican Study Committee (a large conservative caucus in the House, whose members are generally aligned with Paragon) to explore a possible scaled-back extension of the ACA enhanced...

Despite President Trump’s request for a 40% reduction in NIH funding for FY26, Congressional appropriators are preliminarily moving in the direction of keeping NIH funding flat to modestly positive next fiscal year.

340B Drug Discount Program

The Health Resources and Services Administration (HRSA) has begun accepting applications for a voluntary 340B Rebate Model Pilot Program that will allow drug manufacturers to provide 340B-discounted drug prices using a rebate mechanism. The pilot is set to begin January 1, 2026 and last at least one year. In practice, such rebate models have the...