340B Program Reform Coming
The Trump administration indicated in several drug price reform announcements it would seek to reform the 340B drug discount program. Now, it is proposing a pilot to go down the reform path. The Health Resources and Services Administration (HRSA) is launching a voluntary program to test drug makers paying rebates versus issuing discounts upfront to the qualifying providers, which include some hospitals, federally qualified health centers, and other safety-net providers. The pilot will cover just a small subset of drugs, including those for diabetes, rheumatoid arthritis, and heart failure.
Some brand drug makers attempted to convert to rebates but were stopped by the Biden administration. The Trump administration appears on board, although hospitals and other providers oppose the changes. But 340B badly needs reforms as the drug discounts are not truly being passed on by most providers, who pocket the discounts.
Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-hrsa-340b-rebate-pilot-program-2026
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#340b #drugpricing #hospitals #branddrugmakers
Trump Demands Drug Price Reductions
President Trump sent letters to 17 large brand drug makers, telling them to slash the prices of prescription drugs to match the lowest price in certain foreign countries. Specifically, he asked the drug makers to immediately cut the prices they charge Medicaid patients and stipulate that they will not charge Americans more than prices offered overseas. Trump said proposal from the companies so far were not acceptable. “Most proposals … promised more of the same: shifting blame and requesting policy changes that would result in billions of dollars in handouts to the industry,” the letters stated. Trump said he wants to get “American families immediate relief from the vastly inflated drug prices and an end to the free ride of American innovation by European and other developed nations.”
Trump has issued various executive orders and other announcements that are far-reaching and transformational. In one announcement, he gave drug makers time to comply with lower prices, or he would seek to implement most-favored nation drug pricing.
#mfn #irf #drugpricing #branddrugmakers
Cigna and Aetna Have Positive Results
Cigna reaffirmed its guidance for 2025 and reported higher operating profits in Q2 2025. Cigna is one of the few national plans to avoid major financial woes, in some measure because it shed its Medicaid and Medicare lines of business. Cigna’s services business, including its pharmacy benefits manager Express Scripts, continued to do well. Net income from operations rose 1.1% to $1.9 billion. Revenue grew 11% to $67.2 billion. Its medical loss ratio was just 83.2% in Q2.
Like Humana, beleaguered CVS Health seems on the round to recovery. It raised its 2025 forecast due to strong PBM performance and positive trends at Aetna. The company reported net income of $1 billion in Q2, down from $1.77 billion. The company’s MLR continued to be high at 89.9% in Q2.
Additional articles: https://www.fiercehealthcare.com/payers/evernorth-growth-checked-medical-cost-exposure-delivers-solid-q2-cigna and https://www.modernhealthcare.com/insurance/mh-cigna-outlook-evernorth-health-services-growth/ and https://www.healthcaredive.com/news/cvs-hikes-earnings-guidance-aetna-performance-improves-q2-2025-earnings/756447/ and https://www.modernhealthcare.com/insurance/mh-cvs-health-aetna-q2-earnings/
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#cigna #aetna #cvshealth #margins
Trump Announces Personal Healthcare Data Initiative
The Trump Administration announced an initiative to build more personalized healthcare experiences through partnerships with private sector companies. The administration secured commitments from major healthcare and information technology firms, including Amazon, Anthropic, Apple, Google, and OpenAI. The initiative will create the next-generation digital health ecosystem to improve patient outcomes, reduce provider burden, and drive value. Efforts will focus on promoting a CMS interoperability framework for data-sharing and increasing the availability of personalized tools to help make better health decisions.
Additional article: https://www.cms.gov/newsroom/press-releases/white-house-tech-leaders-commit-create-patient-centric-healthcare-ecosystem
#cms #hhs #trump #interoperability #healthcare
Medicare FFS Rate Announcements
The Trump administration announced a 2.6% payment rate increase for inpatient services in FFY 2026 as well as a mandatory payment model for five common surgical procedures. Hospitals oppose the payment model.
Additional article: https://www.modernhealthcare.com/politics-regulation/mh-medicare-pay-inpatient-hospitals-final-2026/
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#medicare #hospitals
Study Finds PBM Market Highly Concentrated
The pharmacy benefits manager (PBM) market is dominated by a handful of large players and is highly concentrated. In addition, PBMs are part of vertically integrated healthcare companies. The American Medical Association (AMA) study says local PBM markets are highly concentrated across services like rebate negotiation, retail network management and claims adjudication. About 77% of people in prescription drug plans are covered by an insurer that’s vertically integrated with a PBM.
#pbms #drugpricing #healthcare #healthplans
https://www.healthcaredive.com/news/pbm-markets-lack-competition-american-medical-association/756338
Senate Committee Explores Healthcare Reform
The Senate Health, Education, Labor, and Pensions (HELP) Committee discussed various healthcare reforms at a hearing this week. Of course, many ideas for reform varied by party, with some agreement on certain issues. Transparency and pharmacy benefits manager reforms tended to be bipartisan issues, while a single-payer Medicare for All system was supported by Sen. Bernie Sanders and some Democrats.
#healthcare #healthcarereform #medicareforall #pbms #transparency
https://www.medpagetoday.com/publichealthpolicy/healthpolicy/116773
Trump Agency Cuts Face Opposition In Senate
The Senate Appropriations Committee rejected the Trump administration’s proposed funding cut to the National Institutes of Health (NIH) research grants, advancing a measure that would increase the agency’s budget by $400 million. The White House budget called for slashing NIH funding by $18 billion, a decrease of 40 percent. The passage at committee was strongly bipartisan.
#nih #hhs #healthcare #trump #senate
https://thehill.com/homenews/senate/5430915-senate-rejects-trump-nih-cuts
— Marc S. Ryan
