Health care costs

Saving Seniors Money on Prescriptions Act

This bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of prescription drugs.

Specifically, PBMs must (1) disclose certain information underlying cost performance measurements (e.g., exclusions and terms), and (2) report to prescription drug plan (PDP) sponsors (and to the Centers for Medicare & Medicaid Services upon request) an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with this bill's requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations.

In addition, the Government Accountability Office must study federal and state reporting requirements for health plans and PBMs with respect to prescription drug price transparency and recommend ways to streamline these requirements.

Responsibility in Drug Advertising Act of 2025

This bill prohibits direct-to-consumer advertising of new drugs during the first three years following their approval by the Food and Drug Administration (FDA). Direct-to-consumer advertising includes advertising via social media.

Upon request from a drug’s sponsor, the FDA may waive the prohibition during the third year following a drug’s approval if it determines that the direct-to-consumer advertising of the drug would have an affirmative value to public health. Conversely, the FDA may prohibit such advertising beyond the three-year period following approval if it determines that the drug has significant adverse health effects based on post-approval studies, adverse event reports, and other appropriate resources.

The prohibition applies to new drugs approved beginning one year before the bill’s enactment.

Ensuring Outpatient Quality for Rural States Act

This bill allows Medicare payments for covered hospital outpatient services in Alaska or Hawaii to include certain cost-of-living adjustments.

Save our Lone Emergency Services Act or the SOLES Act

This bill requires Medicare payments to sole community hospitals in Alaska or Hawaii to cover at least 94% of the reasonable costs of covered outpatient services.

Enhancing Domestic Drug Manufacturing Competitiveness Act

This bill requires the Government Accountability Office (GAO) to study and report to Congress on key regulatory barriers to pharmaceutical manufacturing in the United States.

Specifically, GAO must identify and assess, including by engaging stakeholders, barriers that impede expansion or siting of pharmaceutical manufacturing facilities in the United States or make the United States less competitive than other countries as a location for such facilities. GAO must consider (1) whether environmental or other regulations significantly delay and increase the cost of expanding or siting pharmaceutical manufacturing facilities in the United States; (2) the potential impact of environmental and other regulations on pharmaceutical supply chain resiliency; and (3) specific actions for regulators to address the identified barriers.

Finally, the report must include recommendations for streamlining regulatory barriers and facilitating technological solutions to foster U.S. pharmaceutical manufacturing.

Esophageal Cancer Awareness Act

This bill requires the Government Accountability Office to report to Congress on (1) the impact of esophageal cancer-related health care spending under the Federal Employees Health Benefits Program (FEHBP) for federal employees and retirees diagnosed with esophageal cancer, and (2) how often FEHBP participants with a high risk of esophageal cancer undergo screenings according to established guidelines.

Jamie Reed Protecting Our Kids from Child Abuse Act

This bill makes certain health care facilities and medical practitioners liable for any physical or mental harm caused by performing a gender-transition procedure on an individual younger than age 18. The liability extends for 30 years after the individual who received the procedure turns 18, and it applies to procedures occurring before, on, or after the bill's date of enactment.

Specifically, the liability applies to

• pediatric gender clinics (medical facilities specializing in the diagnosis and treatment of gender discordance and dysphoria in minors) that provide gender-transition procedures;

• institutions of higher education and hospitals affiliated with those clinics, and

• medical practitioners who perform gender-transition procedures or administer health care related to the procedures at pediatric gender clinics.

Medical practitioners and health care facilities may defend against a liability claim if they neither knew nor had reason to know the individual was a minor.

Additionally, the bill prohibits federal funding for (1) gender-transition procedures performed on minors, (2) pediatric gender clinics, and (3) institutions of higher education or hospitals affiliated with those clinics.

Under the bill, gender-transition procedures generally include surgeries or hormone therapies that change the body of an individual to correspond to a sex that is different than the individual's biological sex. These exclude, however, specified types of interventions, including those that address (1) ambiguous biological sex characteristics or abnormal sex chromosome structure or hormones; or (2) infections or other harms that result from a gender-transition procedure.

Freedom for Families Act

This bill allows individuals to establish and contribute to a health savings account (HSA) without being enrolled in a high-deductible health plan (HDHP), increases HSA contribution limits, and allows tax-free distributions from an HSA during a period of qualified caregiving.

Under current law, individuals may establish and contribute to an HSA if they are covered under an HSA-eligible HDHP. For 2025, HSA contributions are limited to $4,300 for self-only coverage or $8,550 for family coverage (adjusted annually). Individuals who are at least 55 years old may make an additional HSA contribution of up to $1,000 per year. Further, under current law, HSA distributions are tax-free if used to pay for qualified medical expenses.

The bill eliminates the HDHP coverage requirement for purposes of an HSA.

The bill also increases the HSA annual contribution limit to $9,000 for individuals or $18,000 for joint filers (adjusted annually) and eliminates the additional contribution for individuals who are at least 55 years old.

Finally, the bill excludes HSA distributions during a period of qualified caregiving from gross income. The bill defines period of qualified caregiving as any period during which an individual is on leave or not employed due to

• the birth or adoption of a child;

• placement of a foster child;

• caring for a family member with a serious health condition;

• an inability to work due to a serious health condition; or

• certain emergencies related to a spouse, child, or parent on covered active duty with the Armed Forces.

Healthy Equipping And Lending Technical Help Panel Act or the HEALTH Panel Act

This bill provides statutory authority for the Panel of Health Advisors within the Congressional Budget Office (CBO). The panel provides expertise and recommendations to the CBO to support its analysis and cost estimates relating to health and healthcare.

The bill requires the panel to report to the House and Senate Budget Committees on the recommendations the panel provided to the CBO and how the CBO utilized such recommendations. The CBO must publish this report on its website.

The bill also requires the panel to consist of 15 members serving three-year terms. The respective chairs and ranking minority members of the House and Senate Budget Committees, and the director of the CBO, must each appoint three members to the panel.

Medicaid Improvement and State Flexibility Act of 2025

This bill authorizes states to approve their own experimental, pilot, or demonstration project under Medicaid if the project provides certain benefits involving electronic benefits transfer (EBT) cards. (Currently, the Centers for Medicare & Medicaid Services approves Medicaid demonstration projects; such projects are also known as Section 1115 Demonstrations.)

Specifically, the project must provide enrollees who elect to participate with an EBT card to purchase primary care services; enrollees must receive any remaining balance at the end of the year in the form of a cash payment and must also obtain catastrophic health insurance.

Rebuild America’s Health Care Schools Act of 2025

This bill allows hospitals to receive reimbursement under Medicare for certain costs associated with training nursing and allied health students in settings other than the hospital itself.

Currently, hospitals may receive reimbursement under Medicare for the reasonable costs associated with training nursing and allied health students if certain conditions are met; the criteria vary depending on whether the students are enrolled in an educational program that is operated by the hospital or another entity. If the students are part of a program that is operated by another entity, the training must occur at the hospital itself or in areas immediately surrounding the hospital in order to qualify for reimbursement (among other requirements). The bill allows hospitals to receive reimbursement for these costs if the training is conducted at an entity that is related to the hospital (i.e., common ownership or control).

The bill requires the Centers for Medicare & Medicaid Services (CMS) to update regulations to reflect these changes. Additionally, the CMS may not recoup or reduce payments to hospitals with respect to costs that are allowed under the bill and must refund any such recoupments or reductions that occurred during the six-year period prior to the bill's enactment.

Healthy Equipping And Lending Technical Help Panel Act or the HEALTH Panel Act

This bill provides statutory authority for the Panel of Health Advisors within the Congressional Budget Office (CBO). The panel provides expertise and recommendations to CBO to support its analysis and cost estimates relating to health and healthcare.

The bill requires the panel to report to the House and Senate Budget Committees on the recommendations the panel provided to CBO and how CBO utilized such recommendations. CBO must publish this report on its website.

The bill also requires the panel to consist of 15 members serving three-year terms. The respective chairs and ranking minority members of the House and Senate Budget Committees, and the director of CBO, must each appoint three members to the panel.

Choices for Increased Mobility Act of 2025

This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish specific billing codes under Medicare for certain materials used in ultralightweight manual wheelchairs.

Specifically, the CMS must establish at least two billing codes for the base of the wheelchair, with at least one code for a base with titanium or carbon fiber construction material and at least one code for a base without these materials. Suppliers receive the same payment under Medicare for these wheelchairs as would otherwise apply, but may bill beneficiaries for any difference between the payment and the actual charge for the wheelchair. The CMS may require suppliers to inform beneficiaries of their potential financial liability in these cases.

Access to Pediatric Technologies Act of 2025

This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish, upon request, specific payment methodologies for qualifying pediatric technologies under the Medicare physician fee schedule. Qualifying pediatric technologies are medical devices that are (1) covered under Medicare, (2) approved by the Food and Drug Administration, (3) currently billed using a specified temporary billing code for emerging technologies, and (4) predominantly used or specifically designated for pediatric patients.

The CMS must develop a payment methodology for a qualifying pediatric technology upon request from the manufacturer and based on available data, including pricing information and claims data. Manufacturers must include relevant information in their requests to enable the CMS to develop the corresponding methodologies.

Reducing Drug Prices for Seniors Act

This bill requires the coinsurance amount for covered drugs under the Medicare prescription drug benefit to be based on the net price of the drug (i.e., the negotiated price under the prescription drug plan net of any manufacturer price concessions), rather than the list price of the drug, if the net price is lower.