Healthcare at a Tipping Point: Politics and Policy in ‘26

This March 3 webinar aimed to show “how this year may unfold for the drug industry, for payers, and for patients,” according to co-moderator Maggie Shaw, lead editor, The American Journal of Managed Care^®. It opened with a discussion on the Trump administration’s Great Healthcare Plan, a wide-ranging set of proposals covering Most Favored Nation (MFN) drug pricing, expanded health savings accounts, Affordable Care Act (ACA) premium reductions, and pharmacy benefit manager reforms. Co-moderator Peter Wehrwein, managing editor with Managed Healthcare Executive^®, described it as “a gumbo of proposals and policies,” and the expert panelists zeroed in on what the administration can accomplish through executive authority vs what requires Congressional action.

Lindsay Bealor Greenleaf, head of market access policy strategy at ADVI Health, explained that the administration has already used the Center for Medicare & Medicaid Innovation to advance MFN pricing through the proposed GLOBE (Medicare Part B) and GUARD (Medicare Part D) models, while 16 drug manufacturers have voluntarily agreed to MFN pricing—a significant political win. She cautioned, however, that finalizing these models would invite litigation and argued it may be unnecessary. “You have 16 companies now that have voluntarily agreed to MFN pricing across all of Medicaid and for all future drug launches. That is huge,” she said.

Nick Ferreyros, managing director of the Community Oncology Alliance, highlighted the partisan shift underway, noting that drug price negotiation—once a Democratic priority—is now being driven by Republicans. He warned, “That horse is out the door. It is not getting put back.”

The discussion then turned to the expiration of enhanced ACA subsidies, which had covered roughly 24 million people. Both panelists agreed the status quo was unsustainable. Greenleaf pointed to the staggering fiscal cost—"$350 billion over 10 years”—while Ferreyros argued, “We can’t leave cancer patients without affordable health insurance coverage in this country.”

On CMS price negotiation under the Inflation Reduction Act, Ferreyros raised alarm about the impact on community oncology practices, warning that a roughly 49% cut to physician add-on payment amounts to “a practice-ending” scenario. He proposed a reimbursement fix modeled after the GLOBE and GUARD structures that would preserve provider viability without reducing government savings.

Greenleaf flagged declining drug launches—48 in 2024, the lowest since 2019—as a troubling sign for pharmaceutical innovation, especially given the simultaneous pressures of the Inflation Reduction Act, MFN, and the 340B program.

The webinar closed with a discussion of the Make America Healthy Again movement, with Ferreyros and Greenleaf expressing hope that the administration would focus on prior authorization reform and reducing utilization management burdens on physicians.