Letters, Statements & Analysis

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.

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).

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.

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.

On Nov. 9, the Senate voted to end the longest federal government shutdown in history, with Majority Leader John Thune (R-SD) promising to hold a floor vote on a bill to extend the expiring Affordable Care Act (ACA) enhanced premium tax credits (PTCs) in mid-December. On Nov. 19, the Senate Committee on Finance held a hearing to discuss solutions to lower Americans’ health care costs, in which witnesses and Senators primarily focused on the role of the ACA.

AMCP commends ACIP’s commitment to regularly reviewing the scientific evidence underlying national immunization recommendations. We recognize the importance of maintaining guidance that is both scientifically rigorous and operationally feasible across diverse care settings. In that spirit, we offer the following comments on the Committee’s ongoing consideration of vaccine safety and the hepatitis B vaccine birth-dose recommendation.

On Sunday, November 9, Senate Majority Leader Thune announced that he had reached an agreement with a group of 8 Democratic senators and the White House on a deal to end the longest shutdown in U.S. history. On Monday, November 10, the Senate approved the government funding bill by a vote of 60-40, which sends the legislative package back to the House of Representatives.

President Donald Trump announced a series of agreements with Eli Lilly and Company and Novo Nordisk to offer Most-Favored-Nation (MFN) prices on two GLP-1 therapies, semaglutide (brand names Ozempic and Wegovy) and tirzepatide (brand names Mounjaro and Zepbound). This marks the fourth and fifth publicly announced agreements between the Trump administration and pharmaceutical manufacturers, joining earlier announcements with Pfizer, AstraZeneca, and EMD Serono. The manufacturers also agreed to cap prices for insulin products and other commonly prescribed diabetes medications.

On Saturday, October 11, Governor Gavin Newsom signed SB 41, a bill that limits certain business practices employed by pharmacy benefit managers (PBMs) in California. This bill follows previous attempts by the governor to regulate PBMs, including changes implemented in the budget that require PBMs to obtain a license, submit detailed operational and financial statements annually to the Department of Managed Health Care, and act in the best interests of health plans and covered individuals.

Under the current Continuing Resolution passed on March 15, government funding will expire at 12:01 AM ET on the morning of Oct. 1. A Continuing Resolution (CR) extends government funding at existing levels in lieu of passage of a regular appropriations bill—occasionally with minor fiscal changes or additional policy “rider” amendments included—for a predetermined amount of time. Unless Congress reaches a deal on an additional funding package, federal government activities and operations deemed “nonessential” will temporarily cease, while “essential” functions and mandatory spending such as Social Security and Medicare payments will continue under contingency plans determined by federal agencies and the Office of Management and Budget (OMB). Since 1980, there have been 14 government shutdowns, with the longest and most recent shutdown to date occurring from Dec. 22, 2018 – Jan. 25, 2019 under the first Trump administration.

Last month, the Department of Health and Human Services (HHS) abruptly announced the firing of former CDC Director Dr. Susan Monarez, which was followed by the resignation of several CDC officials including former CDC Chief Medical Office Dr. Debra Houry.