Week in Washington

Premium Subsidies Updates

There continues to be uncertainty around the issue of extending enhanced premium tax credits (ePTCs) in the ACA Marketplace. The latest news is that Senate Democrats are preparing to offer a bill that would include a three-year extension of ePTCs. This bill is expected to fail. Senate and House Republicans are still considering if they will offer a competing bill (or bills). It’s unclear what provisions may be included in those bills but it’s unlikely to garner support.  A vote is expected this week or next.

Proposed Medicare Advantage Rule Released:

CMS released it’s the 2027 Contract Year Medicare Advantage and Part D rule. Some key highlights include:

• Star Ratings: CMS is proposing not to implement the Excellent Health Outcomes for All reward (previously called the Health Equity Index reward) from the 2027 Star Ratings and continue the Reward Factor. Also proposed was the removal of 12 measures focused on administrative processes for 2027 measurement year
• D-SNPs: Modify the D-SNP passive enrollment regulations to replace the current requirement that the receiving D-SNP and the relinquishing D-SNP have “substantially similar” provider networks Part D
• Part D: Mainly codifying the IRA changes for 2027 and beyond
• Requesting Public Feedback on MA Program Improvements focusing on modernizing and strengthening the program, enhance competition, and level the playing field for smaller, regional, and less well-resourced MA plans. RFIs include the following topics: Risk Adjustment, Quality Bonus Payments, and Well-Being and Nutrition

340B Lawsuit

The American Hospital Association filed a lawsuit to block changes to the 340B program. Currently the 340b program is expected to have major changes starting January 1^st which would change the current practice of upfront discounts to after the fact rebates.

Tariffs and Prescription Drugs

The United Kingdom and the Trump Administration reached an agreement that prevents the US from imposing tariffs on prescription drugs based in the United States. The Supreme Court is still considering a case as to the legality of many of the current tariffs being imposed.

Vaccine Schedule

The CDC ACIP committee voted to end the decades long recommendation to give babies the hepatitis B shot vaccine at birth. Further changes are expected to the child vaccine schedule.