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Major Drug Policy Developments Major drug policy developments this week. First, the hospital lobby scored a major victory when a court ordered the new 340B rebate pilot paused. The Trump administration is seeking to experiment with rebates as opposed to upfront discounts to curb the growth in the discount drug program. The administration rightfully alleges that the program is unaccountable and does not meet the original safety net purpose. The judge ordered a preliminary injunction against the “hastily assembled” pilot set to kick off on Jan. 1 on the basis it “likely” violates the Administrative Procedure Act’s (APA’s) arbitrary and capricious standard.  The judge noted Congress did authorize the federal government to create a rebate model, but regulators had not followed the APA’s requirements in doing so. Second, Rep. Anna Paulina Luna, R-FL, says she is hopeful Congress will codify President Trump’s executive order on capping prescription drug prices next

Exchange Subsidy Deal 50-50 Some lawmakers are saying that there may be a 50-50 shot at obtaining an agreement to extend enhanced Exchange premium subsidies in January. But there are major obstacles. GOP leaders in each house are tending to gravitate toward the larger conservative side of their caucuses, which is dead set against an extension. Minority Leader Chuck Schumer, D-NY, wants either a clean extension or to hang the issue around the GOP’s neck in midterms. Sen. Bill Cassidy is advocating the possibility of extending subsidies as well as seeding health savings accounts (HSAs) for some and giving Americans the ability to decide one way or another. Another leading compromise would extend for two years with some reining in of the generosity of the enhancements. The bill could come to life in this way. Four GOP lawmakers in the House signed on to a Democratic discharge petition which will

Trump Administration Unveils GLP-1 Pilot True to an earlier announcement, the Trump administration has taken the first step toward more expansive coverage of GLP-1 weight-loss drugs in Medicare and Medicaid. The president announced major deals with GLP-1 drug makers Eli Lilly and Novo Nordisk that both reduce net costs as well as set a proposed maximum $50 copay in Medicare for all coverage of GLP-1s. The new step includes the creation of the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model. Under the model, the Centers for Medicare and Medicaid Services (CMS) negotiates directly with pharmaceutical manufacturers for lower net prices and standardized coverage terms. Negotiation areas include:  Participation will be voluntary for manufacturers, states, and plans. More information will be released in early 2026. The BALANCE Model will launch in Medicaid as early as May 2026 and in Medicare Part D in January 2027. Manufacturers, states,

Strategy On Exchange Subsidies Continues; Another Shutdown Possible House Minority Leader Hakeem Jeffires, D-NY, predicted that an extension of enhanced Exchange subsidies will pass the House with backing from both sides of the aisle. “House Democrats are going to continue to fight to get this extension through the Congress on our side. It will pass with a bipartisan majority,” Jeffries told ABC News’ “This Week.” With four GOP members joining Democrats to force a vote on the floor in January via discharge petition, the likelihood is there that the vote could pass. The three-year extension failed in the Senate, unable to get 60 votes. A bipartisan group there still thinks a compromise including a shorter extension, minimum premiums, an income cap, and fraud protections could be hammered out for each chamber. But there are reported barriers to a deal, including political pressures in the GOP caucus not to vote on any

Trump Moves Ball On Drug Prices President Donald Trump registered more wins on drug price reform. The White House announced that nine additional pharmaceutical companies have agreed to follow a most-favored-nation (MFN) drug pricing policy, with some of the companies throwing in several months’ worth of emergency drug supplies. As with other drug firms, the drug companies will lower the Medicaid prices for drugs that are more expensive than they’re sold in other countries, although prices are already deeply discounted through federal and state rebate programs. The firms will also deeply discount cash-pay customers’ drugs via the TrumpRx website. The deals also guarantee MFN prices on all new innovative medicines the nine companies bring to market. Trump has now reached deals with 14 of the 17 drug makers to which he sent letters in July demanding that they lower prices. At the same time, the Centers for Medicare and Medicaid Services

Exchange Saga Top House Democrats on Thursday called on House Speaker Mike Johnson, R-LA, to hold an immediate vote under the discharge process on extending the enhanced Exchange premium subsidies so they do not expire at the end of the year. Johnson is unlikely to do this due to objections from conservative caucus members. The House adjourns tomorrow for rest of the calendar year. A discharge petition for a bill to extend the subsidies received 218 signatures, including four moderate GOP lawmakers who snubbed the Speaker after he broke promise to run an amendment on the subsidy extension. These members are now working with moderates in the Senate to vote on a consensus bill in January. #exchanges #coverage #healthcare https://thehill.com/homenews/house/5654903-jeffries-democrats-johnson-obamacare-subsidies/?tbref=hp More Charged For Fraud in MN The Department of Justice (DOJ) charged more individuals as part of a huge Medicaid fraud scandal in Minnesota. In part the scandal focuses on

Houses Passes GOP Healthcare Reform Bill The House passed its healthcare reform today with no vote or provisions to extend the enhanced Exchange premium subsidies. The vote was 216-211, with one Republican defecting. By and large, the bill does little to solve the affordability problem: The vote comes after Speaker Mike Johnson, R-LA, broke his promise to hold a vote on a subsidy amendment. Johnson broke his word after conservatives objected. The GOP leadership blames the backtrack on no plan from moderates to pay for the major cost of the extension. But the caucus recently passed the One Big Beautiful Bill Act (OBBBA) without major offsets, increasing budget deficits by $4.1 trillion with interest over 10 years. And conservatives on the Rules Committee turned down moderate amendments and simply did not want to allow a subsidy vote. Given the duplicity of the speaker, GOP Reps. Rob Bresnahan (Pa.), Brian Fitzpatrick

Speaker Rebuffs Moderates On Exchange Extension Vote In a rebuff to moderates in his caucus, House Speaker Mike Johnson, R-LA, said he won’t call a vote to extend the Exchange enhanced subsidies. Moderates are livid that the speaker has broken his promise to hold a vote. Johnson says the party’s leadership was unable to reach an agreement with moderates on offsetting cuts to the pricey extension. But moderates did submit multiple amendments to the Rules Committee to pay for part of the extension. Conservatives refused to vote to support the vote on the amendment. Moderates likely still vote for the main House reform bill to be voted on. But some media say some GOP moderates have not ruled out signing onto a Democratic-led discharge petition to force a vote on a three-year extension. But other media report that this is unlikely. Four GOPers would be needed to hit 218 to

No Smooth Sailing: Agreement To Run Exchange Amendment Hits Rocks An agreement between moderate Republicans and the House GOP leadership to allow a vote on an amendment to extend the expiring Exchange is in doubt as the two sides squabble over whether any extension will be paid for by spending offsets. The amendment would extend the enhanced subsidies for two years but add certain eligibility reforms. But the House leadership is demanding spending offsets due to conservative objections. A full subsidy extension would cost about $35 billion a year. Conservatives could derail the amendment in the Rules Committee even before it gets to the floor. GOP moderates could vote against the bill as a whole and sink it as Democrats will not support it. As an alternative, the GOP moderates could team up with Democrats to force a vote via one of several discharge petitions, which need 218 signatures to

House GOP To Allow Vote On Exchanges But By Amending Major Reform Bill Two major decisions from GOP leaders in the House today. First, it will allow a vote on an Obamacare extension to appease several dozen vulnerable Republicans in swing districts. Second, but this will come via an amendment on a broad reform bill from Republicans focused on more conservative reforms. The main bill will feature the following reforms. Exchange cost-sharing subsidies would be funded to lower Silver premiums. This has positive and negative effects depending on subsidy status and income. Greater self-insurance provisions would be included, along with pressing for cheaper plan designs. Some pharmacy benefits manager reforms would be included. Even if the amendment passed, the bill would ultimately not pass in all chambers because it would be viewed as a poison pill by Democrats, especially in the Senate. Democrats are attempting to force a separate vote