Health care costs

Supporting Our Seniors Act

This bill establishes a commission to investigate and make recommendations on an annual basis about policies to address aspects of long-term care, such as financing options, affordability of services, and caregiver supports. The commission terminates 10 years after the bill's enactment.

Comprehensive Reimbursement Initiative Targeting Investment and Care in rural Locations or the CRITICAL Act

This bill increases the Medicare payment rate by 4% for services provided by critical access hospitals in Alaska and Hawaii.

Protecting Patients from Deceptive Drug Ads Act

This bill establishes civil penalties for false or misleading communications about prescription drugs by certain entities on social media. It also requires additional disclosures and reporting relating to drug advertisements on social media or via telehealth.

The bill’s civil penalties apply when social media influencers or health care providers make communications regarding prescription drugs, using social media platforms, from which they financially benefit that (1) are made knowingly or recklessly and are false or inaccurate, or (2) fail to include the brief summary information (i.e., side effects, contraindications, effectiveness) required in drug advertisements. The Food and Drug Administration (FDA) must issue guidance and publish notice of such enforcement actions. The FDA may notify drug manufacturers when such communications fail to include the brief summary information.

The bill also requires telehealth providers (i.e., entities that use telecommunications to bring together patients and drug prescribers or dispensers) to include the brief summary information in prescription drug advertisements.

Also, payments from drug manufacturers to health care providers or social media influencers, or from health care providers to influencers, for communications promoting prescription drugs must be reported in accordance with anti-kickback laws for federal health care programs.

Additionally, the FDA may conduct market surveillance regarding prescription drug promotion on social media, including analyzing communications and establishing a task force with the Federal Trade Commission.

Fatal Overdose Reduction Act of 2025

This bill establishes a five-year Medicaid demonstration program to support the provision of comprehensive and accessible services to treat opioid use and substance use disorders.

Specifically, the bill establishes a demonstration program through which states may receive a Federal Medical Assistance Percentage (i.e., federal matching rate) of at least 90% for services provided by organizations that serve as Health Engagement Hubs. States must certify that these organizations provide a certain level of services, including physical and behavioral health services that are easily and quickly accessible, peer support services, and targeted case management. Organizations must also meet specified minimum staffing requirements, have a community advisory board, and be equipped to provide certain social services (e.g., employment counseling).

The Centers for Medicare & Medicaid Services (CMS) may select up to 10 states to participate in the program. The bill provides funds for state planning grants and administration of the program.

The CMS must contract with an entity to evaluate the program, and the Government Accountability Office must report on this evaluation.

More Behavioral Health Providers Act of 2025

This bill provides for additional Medicare payments to health care practitioners who provide services in mental health professional shortage areas for individuals with mental health or substance use disorders. The bill applies to physicians, physician assistants, nurse practitioners, clinical nurse specialists, clinical social workers, clinical psychologists, marriage and family therapists, and mental health counselors.

Innovation in Pediatric Drugs Act of 2025

This bill expands the Food and Drug Administration’s (FDA’s) authority with respect to research on rare pediatric diseases, including by permitting the FDA to require pediatric studies on certain orphan drugs and to take enforcement action against drug sponsors that fail to satisfy pediatric study requirements.

Specifically, the bill would impose pediatric study requirements on drugs for rare diseases or conditions (i.e., orphan drugs) if the FDA determines that (1) the drug could improve the treatment, diagnosis, or prevention of a disease compared with currently available products for the relevant pediatric population; or (2) there is a need for additional options within the drug’s class or indication. (Under current law, pediatric study requirements generally do not apply to orphan drugs.) The FDA must issue guidance describing how these changes will be implemented, including information on how waivers will be granted.

The bill also permits the FDA to take enforcement action against drug sponsors that fail to comply with pediatric study requirements, if such sponsors demonstrated a lack of due diligence in satisfying the requirements.

Additionally, the bill authorizes the National Institutes of Health to allot a certain amount of funds for priority pediatric research, including research on drugs with no remaining patents on which pediatric studies are needed.

Finally, the Government Accountability Office must report on the bill’s impact on rare disease drug development and on the availability of pediatric information on orphan drugs.

Finn Sawyer Access to Cancer Testing Act

This bill provides for coverage of certain cancer diagnostic and laboratory tests under Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). Specifically, the bill provides for coverage of microarray analysis, DNA and RNA sequencing, whole-exome sequencing, and other next-generation sequencing for individuals diagnosed with cancer.

Additionally, the Department of Health and Human Services must establish an education and awareness program for physicians and the public about genomic testing and the role of genetic counselors.

This joint resolution nullifies the rule titled Medicare Program; Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin (IVIG) Items and Services Rate Update; and Other Medicare Policies, which was issued by the Centers for Medicare & Medicaid Services on November 7, 2024.

The rule sets Medicare payment rates for 2025 for home health services, disposable negative pressure wound therapy (dNPWT) devices, and intravenous immune globulin (IVIG) items and services. It also specifies changes to reporting and participation requirements for providers of home health services and long-term care facilities under Medicare, including a requirement that long-term care facilities report additional data regarding acute respiratory illnesses.

This bill modifies provisions related to market exclusivity for a generic drug.

Currently, the Food and Drug Administration (FDA) awards 180 days of exclusivity on the market to a first applicant to file a qualifying application for market approval of a generic drug. Generally, this exclusivity period begins upon a first applicant's commercial marketing of the drug.

The bill authorizes the FDA to approve a subsequent generic drug application prior to a first applicant's first date of commercial marketing if (1) the subsequent application is ready for full approval, (2) the applicant certifies that there are no conditions that would prevent commercial marketing of the drug within 75 days of approval and that the applicant intends to do so, (3) a first applicant's application has been pending for at least 33 months, (4) the approval of a first applicant's application is not precluded by patent infringement claims asserted against that first applicant, and (5) no first applicant's application has been effectively approved on the date that all such conditions are met.

If an applicant fails to begin commercially marketing their drug within 75 days of approval via the aforementioned process, the applicant's approval is deemed tentative and the applicant is no longer eligible for subsequent approvals, unless the applicant certifies that the failure was due to unforeseen issues that have since been resolved.

This bill provides a tax deduction for health insurance premiums paid to provide medical insurance coverage for an individual, the individual’s spouse, and the individual’s dependents. Under the bill, the tax deduction may be claimed as an adjustment to income (also known as an above-the-line tax deduction), which does not require the individual to itemize deductions.

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.

This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish drug adherence guidelines for covered drugs under Medicare so as to achieve an adherence rate of 90%. The CMS must incorporate artificial intelligence and machine-learning technologies and promote generics and biosimilars when developing the guidance.

Protection from Obamacare Mandates and Congressional Equity Act

This bill alters provisions relating to the requirement to maintain minimum essential health care coverage (i.e., the individual mandate), as well as provisions relating to health care coverage for certain executive branch and congressional employees.

Specifically, the bill exempts individuals from the requirement to maintain minimum essential health care coverage if they reside in a county where fewer than two health insurers offer insurance on the health insurance exchange. Under current law, there is no penalty for failing to maintain minimum essential health care coverage.

The bill also requires certain executive branch and congressional employees to participate in health insurance exchanges. Under current law, Members of Congress and their designated staff are required to obtain coverage through health insurance exchanges, rather than the Federal Employee Health Benefits (FEHB) Program. Current regulations authorize government contributions toward such coverage and require Members of Congress to designate which members of their staff are required to obtain coverage through an exchange.

The bill requires all congressional staff, including employees of congressional committees and leadership offices, to obtain coverage through an exchange. The bill also prohibits Members of Congress from having the discretion to determine which of their employees are eligible to enroll through an exchange. Further, the President, Vice President, and executive branch political appointees must also obtain coverage through exchanges, rather than FEHB. The government is prohibited from contributing to or subsidizing the health insurance coverage of the officials and employees subject to this requirement, including Members of Congress and their staff.

Lead by Example Act of 2025

This bill provides that, beginning January 3, 2027, the only health care plan the federal government may make available to Members of Congress and congressional staff shall be health care provided through the Department of Veterans Affairs (VA).

By September 15, 2025, the VA and the Office of Personnel Management shall jointly submit to Congress a plan to carry out this bill, including recommendations for any necessary legislative actions.

Preventing Medicare Telefraud Act

This bill establishes conditions for payment of certain telehealth services, laboratory tests, and durable medical equipment under Medicare.

Specifically, the bill conditions payment for certain high-cost laboratory tests and durable medical equipment that are ordered via telehealth on at least one in-person visit during the preceding six-month period. Additionally, practitioners must submit claims for separately billable telehealth services under the practitioner's unique national provider identification number.

Healthy Technology Act of 2025

This bill establishes that artificial intelligence (AI) or machine learning technology may be eligible to prescribe drugs.

Currently, certain drugs may be dispensed only upon a prescription provided by a practitioner licensed by law to administer the drug. Under this bill, an AI or machine learning technology may qualify as such a prescribing practitioner if the technology is (1) authorized by state law to prescribe the drug involved; and (2) approved, cleared, or authorized under certain federal provisions pertaining to medical devices and products.

Health Care Prices Revealed and Information to Consumers Explained Transparency Act or the Health Care PRICE Transparency Act

This bill provides statutory authority for requirements for hospitals and health insurance plans to disclose certain information about the costs for items and services.

Specifically, hospitals must publish in their list of standard charges certain rates negotiated with insurers, discounts for cash payments, and billing codes. Further, hospitals generally must publish the standard charges for the services provided by the hospital that may be scheduled in advance.

Additionally, insurance plans must publish the in-network and out-of-network charges for covered items and services and the negotiated prices for covered prescription drugs. Plans must provide a tool for consumers to search for this cost information. Consumers also may request additional information about the costs of specific items or services under their plans.

Medicaid Third Party Liability Act

This bill modifies requirements relating to Medicaid third-party liability.

Current law generally requires legally liable third parties (e.g., health insurers) to pay claims before Medicaid. However, Medicaid must pay first (and seek reimbursement from liable third parties) for claims for (1) preventive pediatric care, and (2) services for an individual for whom child support enforcement is being conducted by the state. The bill repeals these exceptions.

Current law also requires state Medicaid programs to take all reasonable measures to identify legally liable third parties. The bill specifically prohibits federal Medicaid payment for services to individuals for whom third-party insurance information was not obtained and verified by the state.

Doctor Knows Best Act of 2025

This bill prohibits health insurance plans (including federal health care programs) from imposing a prior authorization requirement, utilization management technique (e.g., step therapy or fail-first protocol), or medical necessity review for any item or service for which benefits are available under the plan.

The prohibition is effective for plan years beginning on or after January 1, 2026.