Top News
Senate Judiciary Committee Postpones Hearing on Prescription Drug Costs
The U.S. Senate Committee on the Judiciary was scheduled to hold a hearing on Tuesday, August 4, titled “Prescribing Sunshine: How Competition and Transparency Lowers Prescription Drug Costs,” but has since postponed it as the Committee turns its attention to advancing Todd Blanche’s nomination for Attorney General. Senator Grassley (R-IA), Chair of the Senate Judiciary Committee, has been a vocal proponent of lowering drug costs and cracking down on pharmaceutical patent gaming, including by advancing the Roundtable-supported Affordable Prescriptions for Patients Act (S. 1041). It was anticipated that significant discussion during the hearing would center on Inflation Reduction Act (IRA) negotiation, patent reform, biosimilar competition, and pharmacy benefit manager (PBM) practices. The Roundtable will provide an update once the hearing is rescheduled.
CMS Releases Preliminary CY 2027 Medicare Part D Bid Data, Confirms End of Premium Stabilization Demonstration
On July 28, CMS released preliminary CY 2027 Medicare Part D bid data. This information will help plan sponsors finalize their Part D and Medicare Advantage (MA) offerings ahead of Open Enrollment, which begins October 15. For 2027, the National Average Monthly Bid Amount (NAMBA), used to calculate government subsidies, will be $296.05. The base beneficiary premium, which sets the starting point for plan-specific premiums, will be $41.33. Under the Inflation Reduction Act, this premium is capped at 6% through 2029. CMS reported that finalized premium figures will be published in mid-to-late September.
CMS also announced the end of the Part D Premium Stabilization Demonstration. The voluntary program, introduced in CY 2025 for standalone prescription drug plans, was designed to offset premium increases tied to benefit changes mandated by the Inflation Reduction Act. The program had provided billions of dollars in federal subsidies to insurers over the past two years to help contain drug plan premiums for Medicare beneficiaries. In a social media post, CMS Administrator Dr. Mehmet Oz said the administration is “stabilizing the market so this bailout is no longer needed,” adding that most Medicare recipients would see premium increases of less than $10, with many seeing lower premiums. He characterized the prior subsidy approach as an unnecessary transfer of taxpayer funds to insurers. However, some have raised concerns that ending the subsidies could result in significantly higher premiums for millions of beneficiaries at a time when cost-of-living pressures are already a top concern. Roughly 25 million Americans currently hold standalone Part D plans, with average monthly premiums of about $36. Specific plan-level premium impacts will not be known until CMS releases individual plan pricing in September.
CY 2027 Medicare Physician Fee Schedule Proposed Rule Summary
On July 14, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2027 Medicare Physician Fee Schedule (MPFS) proposed rule. In addition to physician payment updates, the proposed rule includes changes to the Medicare Shared Savings Program, the Quality Payment Program, and the Medicare Prescription Drug Inflation Rebate Program. Comments on the proposed rule are due by September 14, 2026. The Healthsperien team has prepared a summary of the CY 2027 Medicare Physician Fee Schedule proposed rule, available here.
Administrative Action
HHS and Stakeholders Pledge to Advance National Behavioral Health Quality and Best Practices
On July 29, HHS Secretary Robert F. Kennedy Jr. announced that dozens of insurers, medical societies, providers, and behavioral health experts signed a pledge to strengthen the nation’s behavioral health system. The pledge includes committing to timely access to care, evidence-based treatment and recovery support, quality and outcomes measurement, patient-centered recovery-focused care, clinical judgment grounded in individualized patient need, and whole-person care that addresses co-occurring physical conditions alongside behavioral health treatment. The announcement, made at HHS headquarters and framed as part of the Trump administration’s “Great American Recovery” initiative co-chaired by Secretary Kennedy and White House Senior Advisor Kathryn Burgum, also drew supportive statements from CMS Administrator Dr. Mehmet Oz and Substance Abuse and Mental Health Services Administration’s (SAMHSA) Timothy Westlake, who tied the pledge to the Make America Healthy Again movement’s prevention-first, outcome-focused approach to addiction and mental illness.
Revised 340B Rebate Model Program Announced by HRSA
On July 31, the Health Resources and Services Administration (HRSA) announced a revised 340B Rebate Model Pilot Program, giving qualifying drug manufacturers a voluntary option to deliver the 340B ceiling price to covered entities through rebates rather than upfront discounts for a limited set of outpatient drugs. The change follows stakeholder input, including over 2,400 comments on an earlier Request for Information (RFI), and aims to improve transparency and program integrity amid rapid program spending growth. Under the pilot, manufacturers would issue rebates after validating eligible claims, with the goal of strengthening transaction-level verification, preventing duplicate discounts, and supporting coordination with the Medicare Drug Price Negotiation Program. HRSA hopes to modernize oversight of the program while preserving its long-term sustainability and its core mission of expanding healthcare access for rural and medically underserved communities.
Manufacturers wanting to participate must submit rebate plans to HRSA by August 24, 2026, with approved plans taking effect January 1, 2027.
FDA Selects Dexcom as First Participant in ACCESS Model TEMPO Pilot Program
The U.S. Food and Drug Administration (FDA) announced Dexcom, Inc. as the first manufacturer selected to participate in the Technology-Enabled Meaningful Patient Outcomes (TEMPO) for Digital Health Devices Pilot program. Dexcom will also offer the technology as part of the Centers for Medicare and Medicaid Services (CMS) Innovation Center’s Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model. The ACCESS Model aims to improve health outcomes for Medicare beneficiaries managing certain chronic diseases, while the TEMPO pilot will collect, monitor, and report real world data of the devices’ impact on patient outcomes for ACCESS participants.
As the first TEMPO pilot participant, Dexcom’s Glucose Health Program will help patients, their health care professionals, and their caregivers monitor the patient’s metabolic and nutritional status, share tailored guidance, and access real time data and AI insights to support informed decision-making and behavioral modifications. The program can aid in the screening for prediabetes and type 2 diabetes as well as support improved glycemic control and lowered HbA1c in people with prediabetes.
The FDA plans to select up to ten TEMPO pilot participants in each of the four ACCESS Model clinical use areas. Manufacturers interested in participating can send a statement of interest to the FDA, who will continue sending follow-up requests to select potential pilot participants.
Tim Kaine Backs CDC Nominee Erica Schwartz
The Senate Health, Education, Labor, and Pensions (HELP) Committee voted on Thursday, July 30, to advance Erica Schwartz, President Trump’s nominee to lead the Centers for Disease Control and Prevention (CDC). The successful vote came after Senator Tim Kaine (D-VA) announced on July 27 that he would vote to advance Schwartz, citing the need for confirmed leadership amid ongoing outbreaks including measles, screwworm, hantavirus, Ebola, and cyclosporiasis. With his vote, Schwartz becomes only the third Trump Department of Health and Human Services (HHS) nominee to receive a Democratic vote. Schwartz was also supported by all Republicans on the committee following Chairman Bill Cassidy’s (R-LA) decision to back her. Her nomination now moves on to the Senate floor.
SAMHSA Releases Results from 2025 National Survey on Americans’ Experiences with Mental Health Conditions, Substance Use Disorders, and Recovery
On July 27, the Substance Abuse and Mental Health Services Administration (SAMHSA) released the results of the 2025 National Survey on Drug Use and Health (NSDUH), outlining a snapshot of Americans’ experiences with mental health conditions, substance use disorders, and their pursuit of treatment and recovery. The 2025 report is the first year that SAMHSA has been able to report trends on nicotine vaping use. To align the survey results with current medical standards, SAMHSA conducted a Mental Illness Calibration Study (MICS) in the 2023 and 2024 NSDUH to transition mental illness prediction models from the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) to the 5th edition. Additionally, SAMHSA updated survey questions to gather data on adolescent non-suicidal self-harm, adult experiences with sleep disturbances, and adult experiences with chronic pain.
The report found that among people age 12 and older in 2025, 56.0 percent (162.8 million people) used tobacco, vaped nicotine, consumed alcohol, or used an illicit drug within the last month. The percentage of adults 18 and older with any mental illness in the past year showed no change from 2021 to 2025, while the percentage of young adults aged 18 to 25 with any mental illness in the past year decreased over that period. Further, among adults 18 and older who perceived they ever had a problem with drug or alcohol use, 73.0 percent (22.3 million people) considered themselves to be in recovery, while 69.4 percent of individuals who perceived they ever had a problem with their mental health considered themselves to be in recovery or recovered. SAMHSA conducts the NSDUH annually, and results for 2026 will be published next year.
Congressional Action
Democrats Release RFI In Pursuit of Rebuilding Healthcare
On July 30, Democrats released a comprehensive Request for Information (RFI) on rebuilding America’s health insurance system should the Democrats regain control of the White House and Congress in 2029. The effort is led by Senator Ron Wyden (D-OR), who is joined by a dozen other Democratic Senators, and builds on a March 2026 Dear Colleague letter and over 80 listening sessions with nearly 250 advocates, experts, and industry stakeholders. The document argues that Republican policies, including 2025 reconciliation cuts, expiring premium tax credits, and Trump administration rulemaking, represent the largest health care cuts in U.S. history, driving up premiums, deductibles, and the uninsured rate while insurance companies post record profits.
The RFI is organized into three sections seeking public feedback: (1) reversing Republican cuts and reimagining enrollment, affordability, rate review, deductibles, cost-sharing caps, and pathways to universal coverage; (2) simplifying coverage through standardized benefits, network adequacy, prior authorization reform, and appeals processes; and (3) curbing “corporate greed” by limiting insurer profiteering, private equity involvement, Medical Loss Ratio (MLR) gaming, and anticompetitive middleman practices.
This is the second of three RFIs pursuing this broad goal, the first of which sought information on prescription drug pricing. The third will focus on long-term care and is expected to be posted in late summer or early fall. Written comments should be submitted to insurance@finance.senate.gov by October 2, 2026.
State Action
Georgia Proposes Excluding HIV from “Medically Frail” Exemption List Under Medicaid Work Requirements
Georgia’s Department of Community Health (DCH) released a proposed rule on July 9 that would exclude HIV/AIDS from the state’s list of conditions automatically qualifying a Medicaid recipient as “medically frail” and therefore exempt from work requirements. The proposal is intended to align Georgia’s Pathways to Coverage program, a partial Medicaid expansion with work-requirement provisions, with new federal Medicaid eligibility changes included in a tax and spending package passed last year. The current Pathways to Coverage work-requirement waiver expires at the end of this year, and the new federal work requirement takes effect in January 2027.
Under CMS guidance issued in June, able-bodied adults must complete 80 hours per month of work, community service, or education to maintain coverage, a requirement Georgia already applies, while states must provide exemptions for individuals deemed “medically frail.” The federal guidance specifically cites HIV/AIDS, alongside cancer, end-stage renal disease, and sickle cell disease, as an example condition states could include on that list. Georgia’s proposed rule includes one list of automatically qualifying conditions, and a second list of conditions considered case-by-case; HIV/AIDS is not on the automatic list.
Advocacy groups, including Georgia Equality and the Metro Atlanta HIV Health Services Planning Council, submitted comments during the public comment period requesting that HIV be added to the automatic exemption list, framing the request as a matter of correct application of the federal standard and noting that Georgia recorded 2,485 new HIV diagnoses in 2024, with 66,896 residents currently living with HIV. DCH said it is reviewing public comments and will address potential changes at the board’s next meeting. Separately, the Georgia Budget and Policy Institute noted that other provisions in the proposed rule, including broadened exemptions for parents of Medicaid-enrolled children under 13 (up from under 6) and for former foster youth, could expand Pathways to Coverage enrollment, which has totaled roughly 30,000 people since 2023.
Georgia’s proposal comes amid a broader and ongoing legal challenge to the federal “medically frail” definition itself.
Judicial Action
Court Blocks Department of Education from Cutting School Mental Health Grants
On Monday, July 27, a federal judge temporarily blocked the U.S. Department of Education from terminating congressionally funded school-based mental health grants. Without the order, up to nine grants could have been canceled at the end of July. These grants stem from a $1 billion bipartisan congressional appropriation meant to bring 14,000 mental health professionals into schools, particularly in low-income and rural areas. According to the plaintiff states, the programs served nearly 775,000 students in their first year. Sampled projects have also shown a 50% drop in suicide risk at high-need schools, along with reduced absences and behavioral issues.
The Department of Education first moved to discontinue the grants in April 2025, citing conflicts with the administration’s priorities, specifically perceived ties to diversity, equity, and inclusion (DEI) programs. A coalition of states has challenged the cuts in court repeatedly and has now won six favorable rulings. That includes a December 2025 order that found the discontinuations unlawful and imposed a permanent injunction. When the department moved to terminate the grants anyway, the coalition filed a second lawsuit in July 2026 to stop it. The new restraining order bars the department from ending the grants without following required procedural steps, such as working with grantees to resolve issues first. It expires August 24, and a hearing on a longer-term preliminary injunction is expected before then. You can read the full court order here.
Federal Judge Declines to Grant Injunction on Work Requirements
A federal judge in Boston, Richard G. Stearns, declined late on July 29 to block Medicaid work requirements from taking effect on January 1, 2027, ruling that states suing over the policy hadn’t shown enough irreparable harm to justify an injunction. Twenty-five Democratic-led states and the District of Columbia had filed for a preliminary injunction to temporarily block parts of the rule, citing the extraordinary costs incurred by states in staffing and system upgrades that would be needed to install eligibility systems to comply with the rule. The request was denied “without prejudice,” meaning states can seek an injunction again if new evidence of harm emerges. Judge Stearns acknowledged that whether CMS Administrator Mehmet Oz’s stricter medical-frailty standard exceeds what Congress intended remains an open question as the case moves forward.
The ruling comes amid mounting concern from the medical community about how the work requirements will function in practice. States are struggling to determine how to verify which low-income Medicaid enrollees are “medically frail” enough to be exempt from the 80-hour-per-month work, volunteering, or community engagement mandate. Groups including America’s Physician Groups and the American Medical Association (AMA) have warned that forcing physicians to assess patients’ ability to work is unethical, burdensome, and could interfere with patient care, concerns the AMA raised directly with the court in a brief supporting the states’ injunction request.
For now, the underlying lawsuit continues, but states must still prepare to meet the January 1 implementation deadline.
Save the Date: 2026 Annual Conference
HealthCare Roundtable 22nd Annual Conference
November 4-6, 2026
The Mayflower Hotel
Washington, D.C.
