Public Policy Committee Report, October 2025

Members of the Public Policy Committee continue with their activities that affect our community. While there aren’t any significant developments at this time, the Committee still monitors the national scene to provide up-to-date information to our membership.

One example of our involvement is our continuing relationship with the Partnership for Part D Access, the community of patients who are in a group called the 6 Protected Classes. The following report was recently sent out by the Partnership:

THE PARTNERSHIP FOR PART D ACCESS

Recent indications from the Washington Administration have made the Partnership aware that there may be activities in the near term that affect prescription drugs and prescription drug access:

Hill Update

The federal government remains shut down for a second week with no clear path to reopening, as both parties believe they have the stronger public message. The White House and Office of Management and Budget (OMB) are exploring funding workarounds for the military, federal law enforcement, and nutrition programs. At the same time, Democrats push for negotiations on Affordable Care Act premium credits before open-enrollment begins on November 1. Despite workforce reductions, some of which are not publicly disclosed, the administration continues advancing regulatory actions.

Regulatory Developments

The Centers for Medicare and Medicaid Studies (CMS) announced slightly lower Part D and Medicare Advantage (MA) premiums for 2026, emphasizing that plan offerings will remain strong. However, some stakeholders are concerned about rejected bids potentially reducing available services. Reports from the patient advocacy groups indicate inconsistent coverage, with some areas, such as Alaska, lacking plan options despite national coverage claims. Additionally, following meetings with CMS staff in Summer 2024, it is encouraging to see the agency's progress in making Plan Finder more patient-centered and easier to use, including an AI tool to simplify access to pricing information. Finally, Pfizer and AstraZeneca have agreed with the White House to offer Americans Most-Favored-Nation (MFN) prices, and more manufacturers are expected to follow. At the same time, the Center for Medicare and Medicaid Innovation's (CMMI) unified agenda for 2026 lists two pricing models and a voluntary Part D MFN option currently under consideration at OMB. There are growing concerns that shared savings arrangements could restrict access to 6PC.

Coalition Activities

Interviews continue to educate officials regarding 6PC policy. The team is also developing an educational patient journey map highlighting the benefits of the 6PC policy at each stage of care.

The Public Policy Committee is planning a review of the activities with OPTN modernization that it will share with the membership in the January e-newsletter.