Last week was an active week for health policy! Our Founder and CEO, Liz Powell, Esq., MPH attended the Milken Institute Future of Health Summit, in Washington, D.C.. She participated in the:

• 11/5: Milken Women’s Health Network Inaugural In-Person Meeting: Selected to serve on this new network, Liz attended this forum that brought together stakeholders including entrepreneurs, advocates, providers, investors and payers to examine key challenges challenges in women’s health and work toward addressing them with collaborations and policy change. Former First Lady Jill Biden spoke at the forum where Liz had the opportunity to share updates on the Women’s Health Advocates efforts.
• 11/6 and 11/7: Milken Health Conference with Venture, Funders, and Founders: This forum centered on improving access to biomedical innovation and representation in clinical trials, with a focus on funding sources and innovative digital technology-enabled modalities.
• NYU Langone Mignone Women’s Health Collaborative Dinner: Brought together leaders to discuss the future of women’s health and elevating the health challenges impacting women the most.

 

Meanwhile the longest government shutdown in history continues with a deal between moderate Democrats and Republicans close to being adopted to ensure salaries are paid, WIC, SNAP, military and numerous other programs are reinstated. Activity by Congress, the Trump Administration and federal agencies of note includes:

 

Congress:

• Congressional Democrats offered a plan to extend Affordable Care Act (ACA) tax credits for one year in exchange for re-opening the government. While this is scaled back compared to their previous position, it is still a non-starter for Republicans, who re-iterated that they would only offer a vote on ACA subsidies once the government reopens. 
• The House is out of session for the sixth week, while the Senate is working the weekend. Majority Leader Thune (R-SD) indicated that the Senate would vote on a package to fund some agencies including the FDA through September 2026, while remaining agencies would be funded on a stopgap through January 2026. 
• A bipartisan proposal led by Reps. Don Bacon (R-NE), Tom Suozzi (D-NY), Jeff Hurd (R-CO) and Josh Gottheimer (D-NJ) would extend ACA premium tax credits for two years, while also setting an eligibility income cap and cracking down on fraud. It is uncertain how Congressional leadership will respond to this proposal and other ACA fixes that are being circulated.

 

Administration & Agencies:

• CMS:
  • Anti-Obesity Drugs: The Trump Administration announced a deal with Eli Lily and Novo Nordisk to offer their anti-obesity GLP-1 drugs at reduced rates to Medicare and Medicaid, which expands access to millions of patients. Medicare would use a demonstration pilot to offer coverage of these products to beneficiaries with obesity, and high metabolic or cardiovascular disease risk. Additionally customers not using insurance will be able to purchase discounted drugs on the TrumpRx platform. As with other recent deals, both companies receive a three-year exemption from pharmaceutical import tariffs.
  • Most Favored Nation (MFN) Pricing: In 2026, the Generating Cost Reductions for U.S. Medicaid (GENEROUS) Model will launch and allow state Medicaid programs to purchase drugs at MFN prices, that CMS will negotiate with manufacturers. Participating states will will have some leeway on what drugs they include in their pilot. 
  • Medicare Physician Fee Schedule (PFS): The final PFS for 2026 was released late last week.
    • The 'efficiency adjustment’ in the draft proposal has been retained. This reduces reimbursement rates by 2.5% for almost 9000 payment codes, with the rationale that technological advances have reduced provider expenses and time for the associated procedures. This has the impact of reducing payments to specialists, while increasing them for primary care providers. 
    • Other notable PFS elements include: Streamlining the process of adding services to the Medicare Telehealth Services List, finalization of the mandatory five year Ambulatory Specialty Model (ASM), and finalizing payment for skin substitutes at a single rate for both outpatient and inpatient settings. 
• FDA: George Tidmarsh, the CDER Director resigned amid allegations that he abused his regulatory authority. The agency is reportedly struggling to find a new director. 
• Global Health: The State Department prepared templates for bilateral health agreements to expand American oversight of disease outbreaks. Countries party to such agreements must notify the US within a day of an outbreak, and provide pathogen samples within five days. The intent is to tie American health aid to compliance with these agreements. 

 

We will continue to post each week so check back every Monday to get the updates!

 

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