Health care costs

Purchased and Referred Care Improvement Act of 2025

This bill specifies that the Indian Health Service (IHS) must reimburse patients for their out-of-pocket costs for authorized purchased/referred care services within 30 days. (The IHS provides medical and dental services directly to American Indian and Alaska Native patients whenever possible. However, when services are not available, IHS beneficiaries may be referred to private providers. This is called purchased/referred care.)

Specifically, the bill requires the Department of Health and Human Services (HHS) to establish and implement procedures to allow a patient who paid out of pocket for purchased/referred care services authorized by the IHS to be reimbursed by the IHS for that payment no later than 30 days after the patient submits required documentation.

Additionally, the bill requires HHS to update applicable provisions of and exhibits to the Indian Health Manual, contracts with providers, and other relevant documents and administrative authorities to incorporate the provisions of the bill.

The bill also replaces statutory references to contract health service with purchased/referred care.

Preserving Patient Access to Accountable Care Act

This bill extends through 2027 certain incentive payments for health professionals who participate in eligible alternative payment models under Medicare.

Mapping America’s Pharmaceutical Supply Act or the MAPS Act

This bill requires the Food and Drug Administration (FDA) to continually update its essential medicines list and identify risks and vulnerabilities in the associated supply chains.

In 2020, in response to an executive order, the FDA published a list of essential medicines deemed medically necessary to have available at all times. The bill requires the FDA to update and maintain this list to include drugs and ingredients (1) related to responding to public health threats and emergency incidents, (2) of greatest priority for providing health care and at high risk of shortage, (3) the shortage of which would adversely affect patients with chronic conditions, and (4) that the Department of Defense (DOD) determines to be critical for military preparedness. The FDA must update the list at least every two years.

Also, the bill requires the FDA to conduct a risk assessment of the supply chains for drugs and ingredients on the list and annually report its findings to Congress. The assessment must include information about key manufacturing materials, drugs with primarily foreign suppliers, manufacturing capacity, relevant public health and national security risks, and risk mitigation strategies.

Additionally, the Department of Health and Human Services, in coordination with other agencies, must map and monitor relevant supply chains to identify vulnerabilities and provide an annual status report to Congress.

Finally, DOD must report to Congress every 180 days on the drugs DOD purchased that were manufactured in or sourced from China.

Prescription Drug Price Relief Act of 2025

This bill requires the Department of Health and Human Services (HHS) to review brand-name drugs annually for excessive pricing and, if a drug is found to be priced excessively, to void any exclusivity granted to its sponsor.

Specifically, HHS must review all brand-name drug prices at least annually and upon petition. If any such drugs are found to be excessively priced, HHS must (1) void any government-granted exclusivity; (2) issue open, nonexclusive licenses for the drugs; and (3) expedite the review of corresponding applications for generic drugs and biosimilar biological products. HHS must also create a public database with its determinations for each drug.

An entity accepting an open, nonexclusive license under these provisions must pay a reasonable royalty to the holder of the relevant patent or approved new drug application, and must price the generic drug or biosimilar below the excessive rate.

Under the bill, a price is considered excessive if the domestic average manufacturing price exceeds the median price for the drug in Canada, the United Kingdom, Germany, France, and Japan. If a price does not meet this criteria, or if pricing information is unavailable in at least three of these countries, the price is still considered excessive if it is higher than reasonable in light of specified factors, including development cost, revenue, and the size of the affected patient population.

The bill also requires drug manufacturers to report specified financial information for brand-name drugs, including research and advertising expenditures.

Rural Hospital Closure Relief Act of 2025

This bill temporarily allows additional hospitals to qualify as critical access hospitals (CAHs) that receive special payment under Medicare.

Currently, in order to qualify as a CAH under Medicare, a hospital must either (1) be located more than 35 miles (or 15 miles in mountainous regions or areas with only secondary roads) from another hospital, or (2) have been certified prior to January 1, 2006, by the state as a necessary provider of services in the area.

The bill allows a hospital to also qualify if the hospital is a small, rural hospital that (1) serves a health professional shortage area, or a high number of low-income individuals or Medicare beneficiaries; (2) has experienced financial losses for two consecutive years; and (3) attests to having a strategic plan to address financial solvency and to committing to provide a service that is in high demand in the hospital's service area. This authority expires nine years after the bill's enactment.

The Government Accountability Office must study the effects of the bill's implementation. In addition, the Medicare Payment Advisory Commission must study and recommend payment systems for rural hospitals under Medicare. The Centers for Medicare & Medicaid Services must subsequently establish a mechanism and issue guidance on how newly designated CAHs may transition to different payment models under Medicare, including any new payment models recommended by the commission.

Safe and Affordable Drugs from Canada Act of 2025

This bill requires the Food and Drug Administration (FDA) to allow for the personal importation of prescription drugs from Canada in certain instances.

Such a drug must (1) be purchased from an approved Canadian pharmacy and dispensed by a pharmacist licensed in Canada; (2) be purchased by an individual for personal use only and in quantities not to exceed a 90-day supply; (3) be filled using a valid prescription from a physician licensed in a U.S. state; and (4) have the same active ingredients, route of administration, dosage form, and strength as an FDA-approved drug. Certain types of drugs may not be imported under this program, such as controlled substances, biological products, or intravenously injected drugs.

An approved pharmacy under this program must be located and licensed in Canada and meet additional requirements, such as participation in ongoing and comprehensive quality assurance programs.

The FDA must publish a list of approved Canadian pharmacies on its website.

Rural 340B Access Act of 2025

This bill makes rural emergency hospitals (REHs) eligible to purchase drugs from manufacturers at discounted prices by participating in the Health Resources and Services Administration’s (HRSA’s) 340B drug pricing program. HRSA’s 340B program requires drug manufacturers that participate in the Medicaid program to sell certain outpatient drugs at discounted prices to entities listed as eligible under current law. Additionally, in 2020, Congress established REHs as a new Medicare provider designation for hospitals in rural areas providing emergency department services, observation care, and other outpatient medical and health services for which the annual per patient average length of stay does not exceed 24 hours. The bill adds qualifying REHs to the list of entities that are eligible to participate in the 340B program.

Improving Care and Access to Nurses Act or the I CAN Act

This bill allows other health care providers besides physicians (e.g., nurses) to provide certain services under Medicare and Medicaid.

Among other changes, the bill (1) allows a nurse practitioner or physician assistant to fulfill documentation requirements for Medicare coverage of special shoes for diabetic individuals; (2) expedites the ability of physician assistants, nurse practitioners, and clinical nurse specialists to supervise Medicare cardiac, intensive cardiac, and pulmonary rehabilitation programs; and (3) allows nurse practitioners to certify the need for inpatient hospital services under Medicare and Medicaid.

Veteran Overmedication and Suicide Prevention Act of 2025

This bill requires the Department of Veterans Affairs (VA) to contract with the National Academies of Sciences, Engineering, and Medicine to report on the deaths of covered veterans who died by suicide during the last five years, regardless of whether information relating to such deaths has been reported by the Centers for Disease Control and Prevention. A covered veteran is any veteran who received VA hospital care or medical services during the five-year period preceding the veteran's death.

Among other elements, the report shall include the total number of covered veterans who died by suicide, violent death, or accidental death, as well as certain demographic information.

Preserving Life-saving Access to Specialty Medicines in America Act or the PLASMA Act

This bill phases-in certain price adjustments for plasma-derived products under the Medicare prescription drug benefit's Manufacturer Discount Program.

Current law requires manufacturers of covered drugs under the Medicare prescription drug benefit to provide a 10% discount for covered drugs during the initial coverage phase (i.e., before a beneficiary reaches the out-of-pocket spending threshold) and a 20% discount during the catastrophic coverage phase (i.e., after a beneficiary reaches the out-of-pocket spending threshold).

The bill phases-in discounts for plasma-derived products over several years, starting with a 1% discount in 2026 for both the initial and catastrophic coverage phases, and ending with a 10% discount beginning in 2030 for the initial coverage phase and a 20% discount beginning in 2032 for the catastrophic coverage phase.

Copay Fairness for Veterans Act

This bill eliminates veterans' copayments for medication, hospital care, and medical services related to preventive health services provided by the Department of Veterans Affairs.

The bill expands the definition of preventive health services to include (1) evidence-based items or services that have an A or B rating in the recommendations of the United States Preventive Services Task Force; (2) immunizations that have a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and (3) with respect to services for women, the preventive care, screenings, and contraceptives provided for in the Health Resources and Services Administration Preventive Services Guidelines in effect as of December 30, 2022, and any contraceptive approved, granted, or cleared by the Food and Drug Administration, any related contraceptive care, and any related services.

Removing Extraneous Loopholes Insuring Every Veteran Emergency Act or the RELIEVE Act

This bill expands eligibility for Department of Veterans Affairs (VA) reimbursement of emergency treatment for veterans who are treated in a non-VA facility. Specifically, the bill waives the requirement that a veteran must have received VA care within the 24-month period preceding the furnishing of emergency treatment if the veteran receives such emergency treatment within the 60-day period following their enrollment in the VA health care system.

Preserving Patient Access to Accountable Care Act

This bill extends through 2027 certain incentive payments for health professionals who participate in eligible alternative payment models under Medicare.

Purchased and Referred Care Improvement Act of 2025

This bill specifies that the Indian Health Service (IHS) must reimburse patients for their out-of-pocket costs for authorized purchased/referred care services within 30 days. (The IHS provides medical and dental services directly to American Indian and Alaska Native patients whenever possible. However, when services are not available, IHS beneficiaries may be referred to private providers. This is called purchased/referred care.)

Specifically, the bill requires the Department of Health and Human Services (HHS) to establish and implement procedures to allow a patient who paid out of pocket for purchased/referred care services authorized by the IHS to be reimbursed by the IHS for that payment no later than 30 days after the patient submits required documentation.

Additionally, the bill requires HHS to update applicable provisions of and exhibits to the Indian Health Manual, contracts with providers, and other relevant documents and administrative authorities to incorporate the provisions of the bill.

The bill also replaces statutory references to contract health service with purchased/referred care.