National – The One Big Beautiful Bill Act (HR 1) was signed into law on July 4, 2025, but many of its key provisions take effect retroactively as of January 1, 2025. HR 1 is a comprehensive legislative proposal that introduces significant changes across federal tax policy, healthcare programs, and government spending. The bill includes reforms to Medicaid and the Affordable Care Act (ACA), adjustments to tax rates and credits, and measures aimed at reducing the federal deficit and encouraging economic growth. In healthcare, the bill proposes changes such as new eligibility requirements for Medicaid, modifications to ACA subsidies, and codification of previous regulatory rules. Supporters argue these reforms will promote fiscal responsibility, reduce long-term federal spending, and encourage workforce participation. Critics, however, raise concerns about potential reductions in healthcare coverage and access, particularly for low-income and vulnerable populations. To read more, check out the White House press release and this GovFacts Explainer article.
A study published in JAMA Network Open reveals that real-time prescription benefit (RTPB) tools designed to help doctors find cheaper medications for Medicare Advantage patients have not led to meaningful savings. The study Prescription Use and Spending After the Introduction of a Real-Time Prescription Benefit Tool analyzed data from 2.8 million beneficiaries across over 78,000 practices, and researchers found no reduction in out-of-pocket or total prescription costs. To learn more, check out McKnight's article here.
Drug Channels Institute (DCI) released an analysis highlighting that pharmacy benefit manager (PBM)-affiliated specialty pharmacies control most of the specialty drug market. The report reveals that nearly 1,900 accredited specialty pharmacy locations are responsible for approximately two-thirds of prescription revenues from pharmacy-dispensed specialty medications. The analysis also notes the growing presence of provider- and health system-owned dispensing channels, indicating evolving dynamics within this market segment. To learn more, check out this website.
The U.S. Department of Labor launched an opinion letter program to provide clear guidance on federal labor laws across five key agencies: the Wage and Hour Division, Workplace Safety and Health Occupational Safety, Employee Benefits Security Administration, Mine Safety and Health Administration, and Veterans’ Employment and Training Service. The website details how to request an opinion letter, offers tips for writing, and explains the submission process.
Humana announced plans to eliminate roughly one-third of prior authorization requirements for outpatient services by January 1, 2026, aiming to reduce administrative burdens and improve patient access to care. The move includes removing authorizations for diagnostic procedures like colonoscopies, transthoracic echocardiograms, and select CT scans and MRIs.
Connecticut – HB 7179 was signed into law late last week. The legislation requires pharmaceutical manufacturers and marketing firms to register annually and submit detailed reports on their marketing activities. It also authorizes the distribution of opioid antagonists through secure boxes and vending machines, under agreements with trained healthcare providers and certified pharmacists.
Iowa – SF 383 was enacted by Governor Kim Reynolds. As a reminder, SF 383 aims to increase transparency, fairness, and consumer choice in the management of pharmacy benefits and prescription drug pricing. Specifically, the bill prohibits PBMs from discriminating against pharmacies, mandates fair reimbursement based on national averages, and requires quarterly reporting of reimbursement rates.
Louisiana – HCR 73 was sent to the Secretary of State, which is the final step in the legislative process for a resolution of this type. The resolution urges the U.S. Congress to address growing concerns around pharmacy benefit managers (PBMs) and their impact on prescription drug affordability and access. Specifically, it calls for increased transparency in PBM operations by requiring detailed reporting of pricing negotiations, rebates, and fees. It also mandates that PBMs pass savings from rebates and discounts directly to consumers and seeks to regulate PBM practices to prevent anti-competitive behavior, such as steering patients toward higher-cost drugs.
Massachusetts – S 2543, titled An Act Strengthening Health Care Protections in the Commonwealth (SHIELD Act), aims to reinforce legal protections for individuals seeking or providing reproductive and gender-affirming health care. Passed by the Senate in June, the House has since introduced its own version of the bill. The legislation prohibits state and local agencies from cooperating with out-of-state investigations into health care services that are legal in Massachusetts. It also enhances privacy protections by restricting the disclosure of personal information related to providers and patients involved in legally protected care.
Missouri – SB 90 died late last week. As a reminder, SB 90 aimed to modify provisions related to alternative therapies and treatments, including the use of psilocybin. Specifically, the bill aimed to establish a legal framework for the therapeutic use of psilocybin and encourages research into its effectiveness. Psilocybin, a naturally occurring psychedelic compound found in “magic mushrooms,” has recently gained attention for its potential therapeutic benefits, particularly in treating conditions such as depression, anxiety, PTSD, and substance use disorders.
Texas – Texas’s special legislative session ended this month and SB 493 was enacted. As a reminder, SB 493 is designed to safeguard the ability of pharmacists and pharmacies to communicate openly about prescription drug benefits. The bill would allow pharmacists and pharmacies to discuss cost-saving options and provide patients with information on drug pricing and benefits without fear of retaliation or penalties.
Industry Watch: Healthcare News
Senate Confirms Monarez To Head CDC
Inside Health policy (July 29) - The Senate voted on party lines to confirm Susan Monarez’s nomination to head the Centers for Disease Control and Prevention (CDC) Tuesday (July 29) -- agreeing to put at CDC’s helm a microbiologist and former HHS and White House official who has said she supports vaccines but who has also sidestepped answering how she feels about some of HHS Secretary Robert F. Kennedy’s controversial views. Republican senators Bill Haggerty (TN) and Dan Sullivan (AK) did not vote, bringing the vote to 51-47. Monarez received support from Senate health committee Republicans during her nomination hearing, with chair Bill Cassidy (LA) specifically praising Monarez’s record on vaccines. Check out the article here.
AARP endorses bill to prevent upcoding in Medicare Advantage
The Hill (July 28) - The senior interest group is putting its backing behind bipartisan legislation aimed at preventing the practice of upcoding in Medicare Advantage, when healthcare providers bill for inaccurate codes to increase their reimbursement. In a statement, AARP noted that upcoding is expected to increase care costs for Medicare Advantage enrollees by $40 billion this year. To read the full article, click here.
Facing new CMS pressure, providers should audit mental health diagnoses, prescriptions: expert
McKnight’s Senior Living (July 22) - Nursing homes should be auditing documentation for all residents with mental health disorders to ensure their diagnoses are compliant with new federal guidance, a well-known clinical reimbursement recommended. Leigh Ann Frick, president of Care Navigation Consulting, made that suggestion while reviewing updated Long-Term Care Surveyor Guidance that went into effect in late April. At over 900 pages, the new manual and appendixes have left many providers still navigating the changes and how best to respond to them. To read more, check out the article here.
How Republicans sidelined the health care industry and pushed through historic Medicaid cuts
STAT+ (July 8) - Republicans swiftly approved President Trump’s tax cut bill last week, despite a full-court press from doctors, hospitals, and patients to beat back some of the largest health care cuts in American history — more than $1 trillion in all over the next decade. To learn more, check out the full article here.
Senate budget-reconciliation bill risks worsening access to care
Washington, D.C. (June 25)- AMA released a press release expressing concerns about the Senate budget-reconciliation bill, citing cuts to Medicaid and Children’s Health Insurance Program (CHIP) funding and changes in eligibility criteria that will reduce patients’ access to care and affect physician practices’ viability, particularly in rural and underserved areas.
Additionally, the AMA pointed to the exclusion of the House-passed effort to connect Medicare physician payment to the cost of running a practice. To read the full story, click here.
SCPC Submits Comment Letter to CMS on 2028 Medicare Drug Price Negotiation Implementation
Washington, D.C. (June 25)- SCPC submitted a comment letter to the Centers for Medicare and Medicaid Services (CMS) regarding the agency’s 2028 Medicare Price Negotiation Program draft guidance. On behalf of the Senior Care Pharmacy Coalition (SCPC), we write to comment on the draft Guidance entitled: “Medicare Drug Price Negotiation Program: Draft Guidance, Implementation of Sections 1191 – 1198 of the Social Security Act for Initial Price Applicability Year 2028 and Manufacturer Effectuation of the Maximum Fair Price in 2026, 2027, and 2028.” We appreciate the opportunity to comment on the draft Guidance, particularly to address several considerations for CMS as the agency implements the Manufacturer Transaction Facilitator (MTF) for Part B drugs dispensed by pharmacies in 2028, when several Part B drugs are expected to be subject to Medicare drug price negotiation. To read the full letter, click here.
The White House Can Lower Drug Prices By Fixing The Market, Not Price Controls
Washington, D.C. (June 16)- Why do we have a medical system in this country where too many people can’t get the treatment that they need?” Vice President J.D. Vance posed this question during his recent appearance on This Past Weekend w/ Theo Von — and it cuts to the core of America’s health care challenges. To read the full article, click here.
Trump Team Expected to Unveil Next Steps on MFN Drug Pricing Soon
Inside Health Policy (June 10) - The Trump administration is expected to release more details in the coming days on its plan to lower drug prices by using the most favored policy through a potential Center for Medicare & Medicaid Innovation (CMMI) model, three people familiar with the matter told Inside Health Policy. HHS already made price offers to pharmaceutical companies based on the MFN policy, according to the White House. Check out the full article here.
As drug price target deadline looms, pharma companies weigh options
STAT+ (June 10) - Trump administration officials are expected to release more details on their plan to lower prescription drug prices in the coming days and have been meeting with pharmaceutical industry leaders about the potential impacts. The drug companies, in turn, have been gaming out possible scenarios — and strategizing how they may respond to the White House, five people involved in the planning said. To read the full article, click here.
CVS retains some liability in Omnicare false claims suit, federal judge say
McKnight’s Senior Living (June 10) - CVS Health Corp. carries some liability for helping its long-term care pharmacy subsidiary, Omnicare, submit fraudulent drug claims for assisted living and other non-skilled nursing residential long-term care facility residents to the federal government, a federal judge ruled last week. Check out the full article here.
Why CVS, Express Scripts Are Suing Over the Arkansas PBM Law
MedCity News (June 8) - Arkansas became the first state to pass a law banning pharmacy benefit managers from owning pharmacies, aiming to curb their market power and reduce drug costs. But major PBMs like CVS and Express Scripts are suing, claiming the law is unconstitutional. To read the full article, click here. Interested in this topic? Check out these other articles on Insurance Newsnet, Arkansas Times, and National Law Review.
Workplace Injuries Incur Increased Costs and Extended Recovery Periods: Travelers
Risk and Insurance (June 4) - While workplace injuries continue to decline, their associated costs are rising significantly, driven by an aging workforce, high employee turnover, and longer recovery times that pose growing challenges for businesses across all sectors, according to recent findings from Travelers’ 2025 Injury Impact Report. To read the full Risk and Insurance, click here.
Trump’s MFN Push Sparks Concerns for Generics, Biosimilars Makers
Washington, D.C. (June 2) - Inside Health Policy released an article on the recent Executive Order. The Trump administration’s push to revive the controversial “most favored nation” (MFN) pricing policy -- alongside ongoing uncertainty around tariffs and Medicare drug price negotiations -- is creating deep uncertainty for the future of generic and biosimilar drug development in the United States, Association for Accessible Medicines (AAM) President and CEO John Murphy told Inside Health Policy in a Monday interview.
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