Top News
Roundtable Signs on to No Surprises Act Independent Dispute Resolution Entity Conflict of Interest Letter to the Administration
On May 14th, the Public Sector HealthCare Roundtable and 47 organizations representing patients, consumers, unions, and employers sent a letter to the Department of Treasury, Department of Health and Human Services (HHS), and Department of Labor urging the Administration to address tactics exploiting the No Surprises Act (NSA) Independent Dispute Resolution (IDR) process. The letter discusses the influence of private equity firms and IDR entities’ conflicts of interest in the growing inflationary story of IDR arbitration cases and payments. We urged the administration to take action to:
- Investigate the independence of currently certified IDR entities;
- Decertify IDR entities with conflicts of interest;
- equire IDR entities to publicly disclose ownership structures, compensation agreements, and outcome data and impose meaningful consequences on patterns of awards that diverge from qualifying payment amounts; and
- Implement up-front eligibility screening to prevent ineligible cases from entering the IDR portal.
The Roundtable will continue to advocate on behalf of public sector purchasers and their beneficiaries to protect the affordability and accessibility of comprehensive health care benefits. The full letter to the Departments of Treasury, HHS, and Labor can be read here.
Federal Agencies Propose Rule to Expand Employer-Sponsored Fertility Benefits
The U.S. Departments of Labor (DOL), Health and Human Services (HHS), and Treasury announced a proposed rule to establish certain fertility benefits as a new category of limited excepted benefits. The proposal addresses employers’ limited coverage of fertility-related treatments and increases benefit options by easing administrative burdens to make in vitro fertilization (IVF) and other fertility treatments more affordable. While most working-age adults receive health coverage through their employer, comprehensive fertility benefits remain out of reach for the majority. The proposed rule sets several requirements for the benefits, including:
- Substantially all of the benefits must be for diagnosis, mitigation, or treatment of infertility or related reproductive health conditions.
- Benefits are capped at a combined lifetime maximum of up to $120,000 for the participant and their beneficiaries, indexed for inflation for plan years starting after 2028.
- Employers must provide a notice that clearly describes the coverage and meets other specified requirements.
The three departments describe the proposed rule as a key part of the Trump administration’s broader push to expand access to fertility benefits, building on the President’s Executive Order on Expanding Access to In Vitro Fertilization. Comments on the proposed rule are due on June 13, 2026.
Administrative Action
FDA Commissioner Makary Resigns
After 13 months as the Food and Drug Administration (FDA) Commissioner, Marty Makary announced that he was resigning from his post. Current senior level official and FDA Deputy Commissioner Kyle Diamantas will be elevated to Acting Commissioner while the White House identifies Makary’s permanent successor. Makary’s departure was likely influenced by Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.’s intent to fire the Commissioner; however, Secretary Kennedy’s intent to fire Makary required the support of the White House before being acted upon. Ahead of Makary’s resignation, President Trump acknowledged that Commissioner Makary had been “having some difficulty,” while characterizing him as a friend.
Makary’s tenure was defined by internal agency turbulence, including thousands of FDA staff layoffs associated with the Department of Governmental Efficiency’s downsizing efforts and the departure of several senior career officials. Additionally, Commissioner Makary faced challenging decisions marked by disagreement from notable political and industry officials on issues related to the abortion medication mifepristone, drug-review processes, and the approval of flavored vaping products. Commissioner Makary’s handling of personnel matters including the firing and later reinstatement of vaccines official Vinay Prasad drew sustained criticism from patient advocates and industry alike.
CMS Announces First Health Care Organizations to Join Prior Authorization Initiative
The Centers for Medicare and Medicaid Services (CMS) shared the list of 29 healthcare organizations that plan to participate in its electronic prior authorization initiative. New coalition organizations include health systems, electronic health record vendors, and data networks in addition to major insurers who voluntarily pledged to simplify and reduce prior authorizations in 2025.
The prior authorization tactic is a part of CMS’s broader Health Technology Ecosystem initiative, which aims to modernize digital health by improving Americans’ access to innovative health technology. The project will encourage collaboration between early adopters and CMS to integrate electronic prior authorization into clinical and administrative systems. By reducing reliance on manual processes, these organizations will also be increasing visibility into their prior authorization processes and improving information handoffs at the technical level.
Despite the push towards electronic prior authorization, a new American Medical Association (AMA) survey found that two-thirds of physicians expect the newest insurer pledges to reform prior authorizations will not make a meaningful difference. Currently, more than 90% of physicians report that prior authorizations delay access to necessary care and negatively impact clinical outcomes. In particular, physicians note that peer-to-peer case reviews are infrequently conducted by appropriately quailed clinicians, further delaying patient care and adding administrative burden.
Insurers reported that their efforts have eliminated 11% of prior authorizations across a range of medical services, representing 6.5 million fewer prior authorizations for patients across the system. Insurance carriers pledged to provide real-time prior authorization decisions to more than 250 million Americans in real-time by 2027. CMS will require electronic prior authorization interfaces for impacted payers across Medicare Advantage, Medicaid, Children’s Health Insurance Program, and Health Insurance Marketplace plans starting on January 1, 2027.
Public Confidence in Federal Agencies Hits a New Low, Poll Finds
Last week, the Kaiser Family Foundation (KFF) released results from the Health Tracking Poll, finding that over 60% of U.S. adults held low confidence in the ability of federal agencies to act independently when acting on their responsibilities over food and drug safety and public health generally. Confidence was highest in the Centers for Disease Control Prevention (40%), followed by Food and Drug Administration (36%) and Environmental Protection Agency (36%), though fewer than half expressed confidence in any individual agency. This sentiment is consistent across party lines, showcasing a general trend of governmental mistrust.
The survey also found broad public distrust of pharmaceutical, food and beverage, and agriculture companies to act in the public’s best interest; however, physicians and health care providers remain the most trusted source of health information, regardless of party identity. These results are consistent with previous polling data on the public’s trust in sources of health information. KFF researchers noted that declining institutional trust could have broader implications for public health communication and policy implementation, particularly during public health emergencies or regulatory debates.
Judicial Action
Pharmaceutical Companies Ask Supreme Court to Stop Medicare Drug Price Negotiation Program
The U.S. Supreme Court (SCOTUS) heard oral arguments on six ongoing petitions to challenge the Inflation Reduction Act’s (IRA) drug price negotiation program (DPNP). The IRA, passed in 2022, established the DPNP, allowing the Secretary of Health and Human Services (HHS) to negotiate prices with pharmaceutical companies for high-cost drugs covered under Medicare. The program has seen bipartisan support from both the Biden and Trump Administrations, with Trump’s Department of Justice asking the Supreme Court to not take this case.
Pharmaceutical companies have brought multiple challenges to the DPNP to lower courts. Despite losing in both the Second and Third Courts of Appeals, pharmaceutical companies are hoping SCOTUS will rule in their favor. They argue that the negotiations violate the companies’ First and Fifth amendment rights to free speech and due process, though participation in the program remains voluntary.
Thus far, the Justices have not appeared eager to hear the case against the program, as reflected in their delayed considerations to AstraZeneca’s petition that was initially set for January of this year. The U.S. Supreme Court will rule on the case at the end of their term in June 2026.
Save the Date: 2026 Annual Conference
HealthCare Roundtable 22nd Annual Conference
November 4-6, 2026
The Mayflower Hotel
Washington, D.C.
