Federal Update: Senate Introduces Comprehensive PBM Reform Legislation

Topic(s):

Legislation & Regulation

On Dec. 4, Senators Mike Crapo (R-ID) and Ron Wyden (D-OR), Chair and Ranking Member of the Senate Committee on Finance, introduced the PBM Price Transparency and Accountability Act (S. 3345). The bill’s introduction signifies Congress’ appetite towards passing pharmacy benefit manager (PBM) reform, with many of the bill’s provisions included in earlier reform proposals adopted at the state level. This includes bans on the use of spread pricing arrangements, delinking PBM compensation from the price of a drug, and increased transparency into PBM contracts and business practices.

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Capitol Hill, U.S. Capitol, IRA Workshop

Letters, Statements & Analysis December 11, 2025

Regulatory Update: CMS Releases CY 2026 Hospital Outpatient Prospective Payment System (OPPS)

On Friday, November 21, the Centers for Medicare and Medicaid Services (CMS) released CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payments Final Rule, updating Medicare rates and announcing policy changes. The rule includes payment increases for hospitals and ASCs meeting quality reporting requirements and outlines significant reforms related to drug payment and procedural lists. There is a 30-day notice for comments on IRA negotiation factors for 2028 (comment period will begin once forms are published).

Legislation & Regulation

A photo of vaccines, syringes and needles

Letters, Statements & Analysis December 5, 2025

ACIP Sign-on Letter

As mostly non-pediatric organizations representing public health, older adults, patients, family caregivers, consumers and healthcare workers, we support everyone having access to every vaccine they need, regardless of their age. In the United States alone, routine childhood vaccinations for children born between 1994 and 2023 are projected to prevent about 1.13 million deaths, and hundreds of millions of illnesses and hospitalizations. Put simply, childhood vaccines make healthy adults.

Legislation & Regulation

Letters, Statements & Analysis December 4, 2025

Federal Update: CMS Releases IPAY 2027 Negotiated Prices

On Tuesday, November 25, the Centers for Medicare and Medicaid Services (CMS) released the Maximum Fair Prices (MFPs) for 15 products selected for negotiation under the Medicare Drug Price Negotiation Program (MDPNP). The MFPs for these products will take effect in Medicare Part D starting in 2027, bringing the total number of products with negotiated prices to 25.