Legislation & Regulation

Signed into law in 2022, the Inflation Reduction Act (IRA) ushered in Medicare prescription drug pricing reforms and imposed caps on out-of-pocket expenses for Part D beneficiaries. While much discussion and analysis has focused on how the IRA will impact Medicare beneficiaries, Part D plans, and government spending, the impact of the legislation will extend to stakeholders across the U.S. health care industry.

Prescription digital therapeutics (PDTs) are software-based therapies shown to benefit those with mental health conditions like depression. However, many PDTs do not currently fit into one of the statutorily defined coverage categories for the Medicare or Medicaid programs, leaving beneficiaries of those programs—which include some of America’s most vulnerable populations—without access to these effective and accessible treatments. AMCP supports the Access to Prescription Digital Therapeutics Act, an important bipartisan bill that would help remedy this disparity by creating a comprehensive benefit category and expanding Medicare coverage to include PDTs.

Policymakers frequently target pharmacy benefit managers (PBMs) in a well-meaning attempt to contain rising drug prices, but some proposed changes could have the opposite effect for patients. AMCP encourages PBM reform efforts to focus on common-sense requirements for transparency reporting by PBMs. It’s time for a more nuanced discussion about PBM reform—one that lowers the temperature and puts patients first.

The Ensuring Community Access to Pharmacist Services (ECAPS) Act of 2025 (H.R. 3164) is an important bipartisan bill that will extend certain COVID-era provisions such as such as testing, vaccination, and common disease treatments that have been a critical lifeline for millions of patients. AMCP urges lawmakers to pass the ECAPS Act to help ensure patients across the country maintain reliable access to testing and treatment for COVID-19, respiratory syncytial virus (RSV), the flu, and potential future threats to public health.

The Academy of Managed Care Pharmacy (AMCP) thanks the Department of Health and Human Services, the Department of Labor, and the Department of the Treasure (collectively, the Departments) for the opportunity to provide comments in response to the proposed rule titled “Enhancing Coverage of Preventive Services Under the Affordable Care Act [CMS 9887–P]” published in the Federal Register on October 28, 2024.

Our Associate Vice President of Congressional Affairs Adam Colborn unpacks the key issues the health policy community should be on watch for when preparing for the incoming presidential administration in a recent article for First Report Managed Care.