Trump Backs MFN Drug Pricing
President Donald Trump expanded his drug reform proposals today by announcing an executive order that seeks to implement the strictest form of international reference pricing (IRP) known as most favored nation (MFN) status pricing. Americans would receive the lowest price for a drug offered anywhere in the world. It appears that the proposal would be for all Americans – across Medicaid, Medicare, and commercial products. Trump said in a social media post that savings would be 30% to 80%. Another report narrowed the number to 59%. Trump said that the most expensive drugs would perhaps be attacked first.
His MFN proposal builds on a rule he attempted to implement for Medicare Part B medical drugs back in Trump 45. It was eventually rescinded by the Biden administration after being struck in court. While the idea was good, it did have many implementation challenges. At the time, Trump said he wanted to do the same for Part D retail drugs.
First, the order says that the administration will report on the MFN prices for drugs within 30 days.
Second, it expects significant progress over the next few months in terms of concessions from drug makers and that they will pay the MFN price of each drug.
Third, if that does not occur, the government will take a number of steps, including issuing a rule implementing MFN and taking other aggressive measures to significantly reduce the cost of prescription drugs and end anti-competitive practices. This would include expanding importation and reimportation to begin to reduce costs.
Fourth, the order also raises the prospect that trade officials will investigate and take enforcement steps againts other nations undercutting market prices and thereby driving up prices in America.
Additional articles: https://www.healthcaredive.com/news/trump-most-favored-nations-drug-pricing-plan/747761/ and https://thehill.com/homenews/5295603-trump-executive-order-prescription-drug-prices/ and https://insidehealthpolicy.com/daily-news/trump-threatens-mfn-if-drugmakers-don-t-cut-prices-seeks-hike-foreign-prices and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/experts-see-problems-most-favored-nation-policy
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#ira #drugpricing #trump #irp #mfn #branddrugmakers
CMS Solicits Input On Third Year Of IRA Negotiations
The Centers for Medicare & Medicaid Services (CMS) issued draft guidance for public comment on the third cycle of negotiations under the Medicare Drug Price Negotiation Program.
The Trump administration wants to increase transparency of the process. It solicits input on Part B negotiations (which are allowed in year three). CMS also wants to renegotiate certain drugs that were negotiated for initial price applicability years 2026 or 2027.
CMS press release: https://www.cms.gov/newsroom/press-releases/cms-releases-draft-guidance-third-cycle-medicare-drug-price-negotiation-program-lower-drug-prices
#ira #drugpricing #branddrugmakers
Medicaid Cuts Unveiled
House Republicans have unveiled an initial budget reconciliation draft of healthcare reductions totaling more than $700 billion out of federal health programs, chiefly from Medicaid. The Congressional Budget Office (CBO) says the bill would cause 8.6 million people to lose health coverage over 10 years. In addition, it says 5.1 million people would become uninsured if enhanced exchange subsidies expire at the end of 2025.
The major Medicaid reductions cover the following:
- Work requirements
- Stricter and more frequent eligibility
- Bars on new provider taxes and reform of current provider taxes as well as caps on state directed payments
- State reimbursement reductions if states cover undocumented immigrants
- Cost-sharing for certain expansion populations
- PBM reform, including a ban on spread pricing
- Repealing certain Biden regulatory actions
The bill also has an orphan drug Medicare negotiation change.
Additional articles: https://www.modernhealthcare.com/politics-policy/house-budget-medicaid-cuts-tax-breaks and https://www.politico.com/news/2025/05/11/energy-and-commerce-unveils-its-megabill-plans-00339830 and https://www.medpagetoday.com/publichealthpolicy/healthpolicy/115553 and https://www.fiercehealthcare.com/regulatory/urban-institute-tax-medicaid-cuts-disproportionately-benefit-high-income-families and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/ec-reconciliation-bill-includes-pbm-orphan-drug-pharmacy-transparency and https://www.healthcaredive.com/news/house-republicans-unveil-medicaid-cuts-work-requirement-eligibility/747728/ and https://www.beckershospitalreview.com/uncategorized/cuts-of-this-magnitude-cannot-be-absorbed-hospitals-slam-republicans-medicaid-proposal/ and https://thehill.com/policy/healthcare/5296402-house-republicans-medicaid-bill/ and https://insidehealthpolicy.com/daily-news/ec-gop-reduces-fmap-states-cover-undocumented-residents
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#budgetreconciliation #trump #congress #healthcare #coverage #medicaid
CMS Reins In Provider Taxes In Draft Rule
The Centers for Medicare & Medicaid Services (CMS) has issued a draft rule that would rein in portions of Medicaid provider taxes. CMS argues that certain waivers granted by the Biden administration violate the spirit of established safe harbors in provider tax rules. The rule would prohibit higher tax rates on Medicaid than on non-Medicaid businesses even if they pass the applicable statistical test. The rule would also bar the use of vague language to disguise taxes that target Medicaid. The rule would immediately end the loophole taxes in several of the most egregious cases while giving a one-year transition period to others.
CMS cites waivers approved for California, Michigan, Massachusetts, and New York, which account for more than 95% of projected federal taxpayer losses under the loophole. CMS estimates that if just two more states adopt these schemes each year, excess federal costs could balloon more than $74 billion over 5 years.
CMS press release: https://www.cms.gov/newsroom/press-releases/cms-moves-shut-down-medicaid-loophole-protects-vulnerable-americans-saves-billions
#medicaid #providertaxes
Kaiser Announces Q1 Results
Kaiser Permanente logged a 2.9% operating margin and 16% increase in Q1 operating revenues. This was largely due to acquisitions.
Kaiser had more than $31.8 billion of operating revenues and $30.9 billion in operating expenses, both well above the $27.4 billion and $26.5 billion a year ago. Operating income was $932 million for Q1, a slight drop from $935 million a year ago.
#kaiser #margins #healthplans
Exchanges Hit Record
A record 24.3 million people signed up for health insurance on federal and state-based marketplaces during the exchange open enrollment period for 2025. The number beat the record set a year ago by nearly 2.9 million — a 13% increase.
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#aca #obamacare #exchanges #coverage
https://www.modernhealthcare.com/insurance/exchange-enrollment-2025-subsidies
Study Finds Commercial Rates Higher when Hospital Is Also In Medicare Advantage
A study published in Health Services Research found that insurers pay 4.7% higher commercial prices on average to hospitals that are a part of their Medicare Advantage (MA) networks compared to those not in network. Other studies have shown an unseemly relationship between hospitals and plans. Plans ask for the best MA rate possible while agreeing to excessive rates on self-insured employers.
#healthplans #hospitals #margins #rates #medicareadvantage #employercoverage
Connecticut May Cap Out-Of-Network Rates
Frustrated by a lack of real progress on out-of-network rate issues, Connecticut Governor Ned Lamont is backing a proposal to cap the rates hospitals can charge for out-of-network services. The measure would bar providers from charging more than 240% of Medicare rates. It would lower payouts by about $700M annually.
#hospitals #surprisebilling #ct
https://www.beckerspayer.com/policy-updates/connecticut-considers-bill-to-cap-out-of-network-costs/
— Marc S. Ryan
