Legislation & Regulation

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 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.