WHITE HOUSE:

Over the last two weeks the White House focused on the President’s peace plan for the Middle East, finding a way to pay the troops (despite the ongoing federal government shutdown), directing federal agencies to create new “Strategic Hiring Committees” as they continue their efforts to shrink the federal government, and announcing new tariffs, this time on heavy vehicles.  Two items of interest for us:

• The President announced the second Most Favored Nation (MFN) pricing deal with a manufacturer, this time with AstraZeneca. Under the terms of the agreement, AstraZeneca will make their drugs available directly to consumers and state Medicaid agencies at lower pricing. 

• They also announced a MFN agreement, specifically for drugs used in IVF treatments, with EMD Serono. As part of the announcement, they’re also expediting a drug for review under a new FDA program. It’s another sign of how the Administration is using the tools of government to accelerate public-private partnerships.

CONGRESS:

As the government shutdown drags on, there doesn’t appear to be an easy end in sight.  The President’s move to make sure the troops are paid (mentioned above), while legally dubious, takes away one of the main pressures to end the shutdown. The biggest issue remains healthcare as federal healthcare subsidies for the Affordable Care Act are set to expire and, with premiums for Obamacare rising significantly, there’s hope that it might help get Congress back to the negotiating table, as Republicans realize that it’s something they need to address. For now, we’re continuing the waiting game as the current shutdown is halfway to the longest shutdown on record. Elsewhere in DC:

• Congress’ inability to move the needle is giving the Administration free reign, although courts are pushingback on OMB’s attempt to impose layoffs. 

• A really good read on how lobbying and advocacy has changed in the Trump 2.0 era. 

• One of the provisions of the One Big Beautiful Bill was a requirement for states to implement increased eligibility verifications for the expansion population. A group of Democratic Senators reached out to the largest contractors in the space to get details on how they plan on rolling out the technology. 

• For all the back and forth about healthcare, the GOP really doesn’t have a clear path forward on how to politically navigate the fact that Obamacare is popular. 

• In addition to the layoffs, thousands of federal employees are retiring and leaving, continuing to put heavy strain on the government.

AGENCIES:

With the government shutdown ongoing, work at the agencies have noticeably slowed. CMS issued a QSO outlining which survey activities will be allowed. You can access a copy here(PDF). As mentioned in the QSO, they are NOT performing revisits related to DPNA’s, although they haven’t yet issued new guidance on how those dates are to be handled. 

The FDA announced the first group of nine awardees for the new pilot program that will receive expedited consideration for federal regulatory approval, bringing the approval time down to 1-2 months. 

This is from last month. It’s an announcement from Frank Cassidy, Assistant Undersecretary at HUD, regarding improvements to the Section 232 program. The full guidance is here (PDF).  

CMS launched a directory for Medicare beneficiaries to identify providers, but it appears that it’s riddled with errors at launch. 

The OIG at HHS released an analysis on the availability of behavioral health providers within MA and Managed Medicaid plans, finding limited options. The summary is here (PDF) while the full report is here (PDF).  

With little fanfare, likely because of the shutdown, CMS released their updated star ratings for MA plans. HealthcareDive has the breakdown. 

FROM THE NOTEBOOK:

• This doesn’t seem all that kosher… AARP reported $9 billion in royalties from United Healthcare MA products.

• Iowa’s new PBM law is facing a new lawsuit, but pharmacy groups are stepping in to defend the law. 

• Another health system is dropping Humana’s MA plan, this time in Colorado. 

• A four-part series from the Minnesota Post on the state’s plan to rebuild the nursing home workforce. 

• The Kaiser Family Foundation did an analysis on the number of MA prescription drug plans available to beneficiaries across the country. 

• A new study found that many of the most expensive drugs covered by Medicare and Medicaid have “low added clinical benefit”. 

• HealthAffairs examined how states are using hospital price caps to save money. 

• Kaiser Health News did a deep dive into the new $50 billion Rural Health Transformation Fund created by the One Big Beautiful Bill.

• For the legally inclined, McKnight’s has a good look at an important legal case that is using recent Supreme Court decisions to challenge CMS’ right to levy fines.  

• Looks like insurance companies are “downcoding” doctor’s claims to lower tiers of reimbursement.