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| Have you been checking your retirement fund balance? No? Good.
Federal workforce cuts, tariff scares, massive federal policy changes. All in a day's news in 2025. I expected this to be an interesting year in Washington, DC, but not this interesting.
Good news for nursing homes, the federal staffing mandate appears to be dead, thanks to a federal judge, but looming prescription drug tariffs will likely raise prices of generic drugs hard, as the major international producers face stiff levies once the Trump Administration rolls them out within the next couple of months.
More good news for nursing homes. CMS proposed rule on 2026 prospective payment system could result in 2.8 percent increase in payments. Higher than most expected.
To those of you laboring in the trenches of the hard work of healthcare, I thank you and am truly grateful for your dedication, even when the world is at its most chaotic.
Paul |
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| | | | Federal Judge Rules Against Nursing Home Staffing Mandate
In a victory for nursing homes, a federal judge in Texas ruled that CMS did not have the authority to mandate staffing levels for nursing homes, and declared that this is a job for Congress. More
HHS Announces Reorganization
The Dept. of Health and Human Services announced a reorganization initiative that the Administration says will result in the reduction of 10,000 employees and save taxpayers $1.8 billion in costs. The program includes the consolidation of HHS' 28 divisions into 15 new divisions. More
Final Medicare Advantage 2026 Rule Removes GLP-1 Coverage Proposal
The Biden Administration's proposed rule to require coverage of weight-loss drugs was not included in the Trump Administration's final rule. The new rule codifies certain Inflation Reduction Act provisions, including prohibition of cost sharing for approved vaccines and $35 insulin co-pays. The rule prohibits MA plans from revisiting prior authorizations once a determination has been made.
Full Rule
Fierce Healthcare
Final Rule Doesn't Include Pharmacy Notice Requirements
The final 2026 Medicare Advantage and Part D rule does not include the draft position that required PBMs to notify pharmacies of their status in their pharmacy network prior to the beginning of open enrollment. In addition, the rule mandates that pharmacies must enroll in the Medicare Transaction Facilitator Data Module, effectively mandating that pharmacies must accept reimbursements that are likely to be less than acquisition cost under terms of the Medicare Drug Price Negotiation provisions of the Inflation Reduction Act.
Senate Approves Key Nominations
The full Senate approved the appointment of Marty Makary to lead the FDA, as well as the appointment of Dr. Jay Bhattacharya to head the National Institutes of Health. Former TV host Dr. Mehmet Oz's nomination as Administrator of CMS was recommended by the Senate Finance Committee and approved by the full Senate on April 3.
Drug Tariffs are Coming
President Trump's new tariff regime has roiled the financial markets and caused anxiety in international trade circles. One area that is has been exempt from the tariffs is imported prescription drugs, but that is unlikely to last.
The President has recently announced that drug tariffs are coming soon, which he believes will force international manufacturers to leave China and set up shop in the US.
Politico
Pharma companies warn EU of manufacturer exodus to the US
CMS Won't Pay for Non-Medical Medicaid Services
A letter from CMS to State Medicaid Directors advises that CMS will no longer grant federal matching funds for 1115 waivers for states to provide non-medical services to Medicaid recipients through Designated Health Programs and Designated State Investment programs. This policy will affect new 1115 applications and applications for renewals of existing programs. More
CMS Proposes SNF Rate Increase of 2.8 Percent
CMS announced the release of its proposed rule on changes to the SNF prospective payment system. The agency is proposing a net increase of 2.8 percent, and is requesting information on streamlining and reducing federal regulatory burdens on Medicare beneficiaries. More
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| | | | Montana Pharmacies Fight Back Against PBMs
Montana pharmacies, weary of being whipsawed by PBMs, have aggressively lobbied the state legislature to implement payment reforms, such as minimum payments for medications. The legislation passed the Montana House by a vote of 98-1, and now awaits consideration by the State Senate.
KFF Health News
Amgen's Lawsuit Against Colorado is Denied
Amgen filed a lawsuit in March 2024 against Colorado's Prescription Drug Affordability Board, which was established in law to set upper limits on drug prices. Amgen's Enbrel was deemed unaffordable by the board, to which Amgen responded with the lawsuit. The judge in the case ruled against Amgen...More
Alabama Legislature Passes Legislation to Regulate PBMs
The Alabama House of Representatives unanimously to approve legislation requiring PBMs doing business in the state to reimburse pharmacies at the Medicaid rate, at a minimum. The bill now goes to the governor for final approval. More
North Dakota Follows Suit with PBM protections
Arkansas Legislature Passes Bill to Prohibit Big PBMS from Owning Pharmacies
The Arkansas legislature has sent a bill to the governor that would prohibit "monopoly" PBMs from owning pharmacies in the state. This would certainly affect CVS healthcare, including leading LTC pharmacy Omnicare. More |
| | | | Turmoil at HHS Causes Anxiety Among Nursing Homes
Mass layoffs and subsequent re-hirings have left healthcare sectors anxious over what comes next. Agencies like CMS and CDC have been affected, which makes nursing home sector executives worry that experienced people are leaving, with no one left to manage the regulatory activity. More
Pfizer Discontinues Work on Obesity Drug
Pfizer announced that it would stop development of danuglipron, its experimental oral GLP-1 medicine to treat obesity, following the detection of liver problems in a clinical trial participant. The company will focus on another candidate in the drug class. More
Walgreens Settles Medicaid Overbilling Allegations
Walgreens has agreed to pay $2.8 million to settle allegations it overbilled Georgia and Massachusetts Medicaid programs by manipulating "usual and customary" pricing reports on certain drugs between 2008 and 2023. More
Could More than 350,000 Immigrant Caregivers be Deported?
Researchers, relying on Census data, have determined that more than 350,000 undocumented immigrants working as caregivers could be deported, in the event President Trumps border security plans move beyond the current phase. The consequences for the health system could be severe...More
Will Rite Aid Re-enter Bankruptcy?
The troubled drug store chain is reportedly considering re-entering bankruptcy. Having emerged from its 2023 bankruptcy in 2024, the chain continues to be under pressure and, absent a buyer, may begin liquidation, according to unnamed insiders. More
Guardian Opens New Pharmacy in Naples, FL
Guardian Pharmacy Services announced the opening of a new pharmacy in Naples Florida, adding to its presence in Southwest Florida.
Guardian Opens New Pharmacy in Columbus, OH
Guardian Pharmacy Services has announced the opening of another pharmacy, in partnership with Mullaney's Pharmacy, Columbus Ohio. The new pharmacy will be known as Guardian Pharmacy of Ohio. More |
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