News Archive

"The problem isn't the DTC model. It's the assumption that the federal government needs to run it.... If the administration wants to expand direct-to-consumer drug purchasing, the most effective role it can play is not to build a federal platform but to eliminate policy barriers that hinder private actors from competing, innovating, and lowering prices on their own."  MORE >>

"[T]he CAA includes several reforms to the pharmacy benefit manager (PBM) industry that represent a major step forward for meaningful health care reform. The PBM provisions included in the final legislation help shine a light on PBM business practices, promote transparency, and ensure that negotiated savings benefit plan sponsors and patients -- not middlemen."  MORE >>

"Within this legislative package, at least two sections stand out as game-changing provisions: [1] Sec. 6223: Assuring pharmacy access and choice for Medicare beneficiaries, and [2] Sec. 6224: Modernizing and ensuring PBM accountability."  MORE >>

Video of Jan. 22 hearing with insurance company executives. Testimony from: [1] Stephen Hemsley, UnitedHealth Group; [2] David Joyner, CVS Health; [3] Gail Boudreaux, Elevance Health; [4] David Cordani, The Cigna Group; [5] Paul Markovich, Ascendiun; and [6] Ellen Allen, West Virginians for Affordable Health Care.

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"Trump's proposal would send the value of the now-lapsed ACA enhanced subsidies directly to consumers rather than route the tax credits through their insurer to bring down premiums.... [T]he plan aims to 'hold big insurance companies accountable' by requiring that they post rate and coverage comparisons online in plain English, making it easier for consumers to shop for coverage. It would also require that health plans publish what percentage of their revenue is paid out to claims compared to overhead costs and profits."  MORE >>

"The [ERISA Litigation Reform Act (HR 6084)] would impose a stay on discovery once a defendant files a motion to dismiss under Rule 12 in any action against a plan or its fiduciaries under Section 502. The stay would be automatic unless the court finds that particularized discovery is necessary to preserve evidence or prevent undue prejudice. The bill would also impose document preservation obligations during the pendency of the stay."  MORE >>

"If the president and Congress follow through on the promise to shift more prescription drugs to pharmacies' over-the-counter sections, they will make medicines cheaper and more accessible -- but, more importantly, they will return a measure of control over health care to patients themselves, where it belongs."  MORE >>

"President Donald J. Trump's Great Healthcare Plan is a broad healthcare initiative that will slash prescription drug prices, reduce insurance premiums, hold big insurance companies accountable, and maximize price transparency in the American healthcare system." [Also available: White House Fact Sheet]  MORE >>

"The Great Healthcare Plan [1] calls for codifying the Trump Administration's Most-Favored-Nation deals to get Americans the same low prices for prescription drugs that people in other countries pay.... [2] funds a cost-sharing reduction program for healthcare plans which would save taxpayers at least $36 billion ... [3] will end the kickbacks paid by pharmacy benefit managers (PBMs) to the large brokerage middlemen ... [4] [creates] the 'Plain English' insurance standard and [requires] insurance companies to prominently post the profits they take out of premiums as well as information on the frequency with which they deny care ... [5] requires any healthcare provider or insurer who accepts Medicare or Medicaid to prominently post their pricing and fees in their place of business[.]"  MORE >>

"PTC opponents have pushed false claims to advocate against extending the enhancements. But as policymakers continue to negotiate an extension to help the millions of people who are seeing their premium costs spike, they should keep the realities of PTCs in mind."  MORE >>

"Ways and Means Committee Chairman Jason Smith (MO-08) and Energy and Commerce Committee Chairman Brett Guthrie (KY-02) announced the details for an upcoming hearing with five of the biggest health insurance company CEOs to answer questions on making health care more affordable for all Americans.... The date of the hearing will be January 22, 2025 ... Company CEOs in attendance will be UnitedHealth Group, CVS Health, Elevance Health, The Cigna Group, and Ascendiun (the parent company of Blue Shield of California)."  MORE >>

"[T]wo air ambulance providers ... have filed a petition for writ of certiorari with the U.S. Supreme Court ... The petition asks the Court to decide a key question that has divided federal courts across the country: whether the NSA permits providers to bring private causes of action to enforce IDR awards in court. Should the Supreme Court grant cert, the outcome of the case could have broad implications for the enforceability of NSA arbitration awards, a key feature of the NSA's regulatory framework." [Guardian Flight, L.L.C. and Med-Trans Corp. v. Health Care Serv. Corp., No. 24-10561 (5th Cir. June 12, 2025; cert. pet. filed Oct. 8, 2025, No. 25-441)]  MORE >>

19 pages. "The need for long-term reforms to Medicare has been repeatedly raised. One is to raise the eligibility age from 65 to the Social Security full retirement age of 67, then tie it to increases in longevity.... In this paper, [the authors] estimate the coverage and spending effects of eliminating Medicare coverage for those ages 65 to 66[.]"  MORE >>

"This brief provides an overview of the role of PBMs in managing pharmacy benefits, discusses recent federal legislation focusing on several elements of PBM business practices, and explains the potential federal budgetary impact of this legislation, which would have a relatively modest impact on the federal deficit, based on available CBO estimates."  MORE >>

"[T]he Fifth Circuit reversed an award of more than $1.8 million in attorneys' fees under ERISA Section 502(g)(1), holding that a claimant who ultimately obtained no substantive relief cannot recover fees based solely on favorable factual findings or judicial criticism of plan procedures." [Cloud v. Bert Bell/Pete Rozelle NFL Player Ret. Plan, No. 25-10337 (5th Cir. Dec. 18, 2025),]  MORE >>

"In the latest survey of leading health care policy scholars ... [most] agreed that proposals to convert enhanced subsidies for [ACA] Marketplace plans into contributions for health savings accounts (HSAs) would have an overall effect of worsening health care affordability for enrollees. There was also consensus that requiring small-dollar premiums (instead of permitting fully subsidized plans with no net premium) would measurably reduce Marketplace enrollment; there was further consensus that a scheduled policy change that will effectively end automatic renewals with subsidy will substantially reduce Marketplace enrollment."  MORE >>

"First and foremost is the role that health care affordability will play in the midterms.... Second ... how enrollees actually respond in the Marketplaces.... [S]tates that have expanded Medicaid will be gearing up for Medicaid work requirements, which kick in in 2027 ... [A]fter years of moderate increases ... health costs will increase more sharply again.... [T]he Trump administration has put pressure on drug prices through a variety of initiatives.... [F]our in 10 Americans say they identify in some way with the MAHA agenda."  MORE >>

"[Some] are pitching the accounts as an alternative to expiring enhanced federal subsidies that have lowered insurance premium payments for most Americans with [ACA] coverage. But legal limits on how HSAs can and can't be used are prompting doubts that expanding their use would benefit the predominantly low-income people who rely on ACA plans.... One group that would almost certainly benefit: a slew of companies selling expensive wellness items that can be purchased with tax-free dollars from the accounts."  MORE >>

"[M]aking patients bear more of their costs out of pocket is a bad way to reduce wasteful health-care spending. It does more to inhibit access to care than to steer patients to cheaper sources of treatment. This is because health-care spending is highly concentrated among the seriously ill, for whom additional expenditures greatly exceed any realistic deductibles. Legislators should instead focus on letting Americans purchase more affordable insurance plans that are better focused on their health needs."  MORE >>

December 3 hearing.  Video and testimony from witnesses [1] Joel White, Council for Affordable Health Coverage; [2] Marcie Strouse, Capitol Benefits Group; and [3] Claudia M. Fegan, MD, Physicians for a National Health Program.  MORE >>

"While gains were made in structuring individual market health plan choices in the ACA, additional standards for plan design, marketing, and enrollment could improve consumer satisfaction and health care affordability. However, progress toward these goals could be undermined by future administrative or congressional changes, such as allowing alternative plan types or rolling back regulations that promote standardization."  MORE >>

"Pursuant to ERISA Section 515, duress is among the defenses that cannot be used as a defense in an action by trust funds to collect delinquent contributions. A claim for economic duress may be preempted by ERISA. A violation of ERISA's claims procedures rule could constitute duress.... While duress can be alleged with respect to a designation of beneficiary or with respect to an agreement to arbitrate, or a forum selection clause, it arises most frequently in the employee benefits context in connection with the validity of releases."  MORE >>

"Whereas HIPAA only covers healthcare providers, payers and clearinghouses and their business associates that electronically transmit data, Cassidy's HIPRA [S 3097] would address the growing number of consumer apps, wellness platforms and wearables that collect consumer health data such as weight, blood pressure readings, sexual health information or other sensitive health information."  MORE >>

"The court determined that ESI's claim that the Act applies only to consumer-oriented acts or practices is a requirement that does not appear in the statute, which was intended to govern the conduct of PBMs, pharmacies, and pharmacists. Additionally, the court found that ESI's interpretation of the statute would render the enforcement mechanism in the Act 'meaningless.' " [Lackie Drug Store, Inc. v. Express Scripts, Inc., No. 23-1669 (E.D. Mo. 2025)]  MORE >>

"[J]udges on an Eighth Circuit Court of Appeals Panel briefly questioned the pharmacy benefit managers (PBMs) accused by the [FTC] of artificially inflating insulin prices by rigging the pharmaceutical supply chain in their favor and preventing patients from accessing affordable life-saving drugs. These PBMs are attempting to stop the FTC's internal proceedings against them while the constitutional challenge plays out.... Essentially, the PBMs are arguing that they will be irreparably harmed if their claims are adjudicated in the FTC's internal administrative proceedings instead of federal court." [Express Scripts, Inc., v. FTC, No. 24-1549 (E.D. Mo. Feb. 18, 2025; on appeal to 8th Cir No. 25-1383; oral arg. Nov. 19, 2025)]  MORE >>