Top 5 Most-Read Reimbursement Content of 2025

Reimbursement policy in the US saw major upheaval in the second half of 2025. New mandates, stalled subsidy negotiations, and pricing pressures created major uncertainty for payers, providers, and patients. Meanwhile, agreements on glucagon-like peptide 1 (GLP-1) therapies offer hope for affordability and access.

From sweeping Medicaid eligibility changes to drug pricing deals, here are the top 5 most-read reimbursement articles of 2025.

5. Medicaid Work Requirements Set to Leave Millions Without Insurance

House Rule 1, dubbed the “One Big Beautiful Bill Act,” was passed in July 2025, introducing Medicaid work requirements that beneficiaries must verify at least 80 activity hours per month every 6 months. The Congressional Budget Office estimated 5.2 million adults could lose Medicaid coverage by 2034, with downstream effects including reduced access to care, worsened health outcomes, and significant financial strain on rural and safety-net hospitals that rely on Medicaid funding. Evidence has linked Medicaid coverage to improved health and increased employment; meanwhile, coverage losses could destabilize access for children and families.

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4. Most Favored Nation Drug Pricing Moves Forward, but Experts Warn Details Are Still Missing

During an MJH Life Sciences^® webinar, experts cautioned that although the Trump administration’s Most Favored Nation (MFN) drug pricing policy is moving forward, major operational and legal details remain unresolved as of November 2025, creating uncertainty for manufacturers, payers, and patients. Panelists outlined 2 proposed demonstration models under review, the GLOBE and GUARD models, and explored the surge in direct-to-consumer drug fulfillment. They also expressed concerns such as potential spillover effects on Medicaid and 340B pricing, saying there is limited potential for Medicaid savings under MFN policy.

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3. Government Shutdown Concluded but ACA Subsidies in Limbo

The 2025 federal government shutdown ended in November without resolving the fate of enhanced Affordable Care Act subsidies, leaving uncertainty around insurance costs for millions of marketplace enrollees. Although Senate Republicans agreed to hold a vote on extending the subsidies, House Republicans had not committed, raising the risk that subsidies could expire at the end of 2025 and cause premiums to more than double for some patients with low income. Policy experts warned that failure to extend the subsidies could increase uninsurance rates, particularly among older adults and people with chronic conditions, compounding coverage losses tied to recent Medicaid cuts.

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2. A "One-Two Punch" to Innovation? The Most Favored Nation Order and Broader US Drug Pricing Reform

Experts said the MFN order could significantly reshape US drug pricing by leveraging “voluntary” manufacturer agreements and the threat of tariffs to force prices closer to international benchmarks. During an MJH Life Sciences^® webinar, panelists warned that aligning US prices with those set by foreign governments could dampen investment incentives, especially combined with the Inflation Reduction Act, and particularly in oncology, where high failure rates make predictable revenue essential for sustaining innovation. Although proponents argue MFN could lower costs for some patients, speakers emphasized that opaque global pricing, legal uncertainty, and potential tariff-driven market disruption may ultimately restrict access, destabilize the biopharma ecosystem, and reduce the pipeline of breakthrough therapies.

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1. Trump Announces Deals With Lilly, Novo to Cut Weight Loss Drug Prices

The White House announced pricing agreements with Eli Lilly and Novo Nordisk in November that are set to sharply reduce the cost of GLP-1 therapies such as semaglutide and tirzepatide for Medicare, Medicaid, and patients purchasing through the new TrumpRx direct-purchase platform. Under the deals, monthly prices for semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound) should fall to roughly $245 for public programs and $350 through TrumpRx. Both companies also committed to MFN-aligned pricing on future products and additional discounts on insulin and other chronic disease drugs.

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