"Congress reached a bipartisan agreement this week on a healthcare funding and policy package included in a larger $1.2 trillion spending bill aimed at averting a government shutdown. The package includes a mix of funding proposals, policy reforms and program extensions designed to support healthcare providers and public health. The bill provides roughly $116 billion in funding for HHS through fiscal year 2026. This is $210 million more than the agency's funding from fiscal year 2025, including a $415 million funding increase for the NIH."
"The agreement does not extend enhanced Affordable Care Act premium tax credits. Those subsidies were introduced during the pandemic to boost healthcare affordability, but they expired at the end of last year. The expiration of these subsidies doesn't just push coverage out of reach for millions of Americans - but it could also create significant cash flow challenges for healthcare providers already battling financial pressures. As premiums rise and enrollment falls, hospitals could see higher uncompensated care and bad debt. Last year, 93% of ACA marketplace enrollees received the tax credits."
"The proposal includes reforms for pharmacy benefit managers, requiring greater transparency and accountability in Medicare Part D. It mandates clearer reporting on PBMs' pricing, rebates and fees, as well as directs CMS to define "reasonable and relevant" contract terms that better reflect pharmacy costs. The bill also delinks PBM compensation from drug list prices and bans certain opaque practices like spread pricing, aiming to reduce incentives for PBMs to push higher‑priced drugs and retain hidden margins. Additionally, the reforms seek to improve pharmacy network access and give pharmacies a process to dispute unfair contract terms."
The package provides roughly $116 billion for HHS through fiscal year 2026, including a $415 million increase for the NIH and $210 million more than FY2025. The agreement does not extend enhanced Affordable Care Act premium tax credits, which expired at the end of last year and could reduce enrollment while increasing uncompensated care and bad debt for hospitals. The proposal enacts pharmacy benefit manager reforms for greater transparency, delinking PBM compensation from drug list prices, banning spread pricing, and improving pharmacy dispute processes. The legislation also extends pandemic-era telehealth flexibilities through 2027 to support provider access and care delivery.
Read at MedCity News
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