Issue #259
Sellers Dorsey Digest
October 23, 2025
Federal News
Trump Administration Announces IVF Coverage Guidance
On October 16, the Trump Administration announced plans to expand access to fertility services. The announcement follows Executive Order 14216, which aimed to expand access to and the affordability of invitro fertilization (IVF). The Departments of Labor, Health and Human Services, and Treasury released joint guidance outlining considerations for coverage and upcoming rulemaking. The guidance introduces supplemental benefits for fertility services and expands employers’ ability to offer these benefits to their interested employees. Additionally, as part of the President’s initiative to align US drug prices with most-favored nation (MFN) prices, EMD Serano, the largest fertility therapy manufacturer, has agreed to lower its prices and sell directly on the TrumpRx.gov website. Notably, a few PBMs have begun to follow suit and lower their distribution costs of IVF treatments, with CVS Caremark announcing that CVS Specialty Pharmacy will be a core partner in the TrumpRx fertility program. CMS estimates that the deal with EMD Serano could save individuals up to $2,200 per drug cycle (White House, October 16; Department of Labor, October 16; Fierce Healthcare, October 17; Health Payer Specialist, October 17; PR Newswire, October 16).
Health IT Group Warns Against Rushing No Surprises Act Price Estimate Requirements
House Republicans are pushing the federal government to implement a key part of the No Surprises Act that would allow patients to see cost estimates before care, but a leading health IT group is urging caution. This policy was intended to go into effect in 2022 but was delayed to allow time for the industry to develop standards for sending electronic data. In a letter that was also sent to the Trump Administration, the Workgroup for Electronic Data Interchange (WEDI) told Republican lawmakers on the House Ways and Means Committee that implementing the policy now without proper technical systems could overwhelm providers and lead to errors. The group suggested beginning with simpler scheduled services until reliable data-sharing standards are in place. WEDI also asked for clearer rules on handling multiple insurers, provider penalties, and the accuracy of estimates. WEDI said taking extra time to build the right infrastructure would improve transparency while avoiding confusion and unnecessary administrative costs (Inside Health Policy, October 17).
Senate Committee to Hold Long-Anticipated Hearing on the 340B Program
On October 23, the Senate Committee on Health, Education, Labor and Pensions will hold a full committee hearing on the 340B program. Representative Bill Cassidy (R-LA) began his investigation into the 340B program in 2023 following several reports indicating that entities may not be appropriately disclosing their revenue. In April 2025, the committee released its investigation findings, including evidence that a few hospitals, FQHCs, contract pharmacies, and drug manufacturers had misused their positions as part of the program, such as failing to use revenue or resources to directly benefit the patients they serve. It is unclear if Representative Bill Cassidy will introduce 340B reform legislation at the meeting as he has previously signaled his interest in introducing a bill to address the misuse of 340B revenue (Inside Health Policy, October 17; Strategic Healthcare, N/A).
State News
California Moves to Regulate Pharmacy Benefit Managers Under New Law
California Governor Gavin Newsom signed new legislation that increases state oversight of pharmacy benefit managers (PBMs), the companies that negotiate drug prices between insurers and pharmacies. The law requires PBMs to obtain licenses from the California Department of Insurance and restricts several practices critics say drive up medication costs, such as spread pricing and directing patients to PBM-owned pharmacies. It also requires rebates to be passed onto patients or insurers and limits the use of exclusivity agreements with drug manufacturers. Supporters, including bill sponsor State Senator Scott Wiener, said the measure strengthens transparency and supports independent pharmacies, while the Pharmaceutical Care Management Association argued it unfairly targets PBMs and could lead to higher drug prices instead of savings. With this law, California joins a growing number of states imposing stricter regulations on PBMs as federal reform efforts remain stalled (Fierce Healthcare, October 13).
Connecticut Health System to Purchase Two Hospitals from Prospect Medical
On October 20, Hartford HealthCare confirmed that it has won the auction to purchase two Connecticut hospitals from Prospect Medical Holdings. Prospect, a private equity firm, owns three hospitals in the state, but filed for bankruptcy in January of this year. The two hospitals in the current sale, Manchester Memorial and Rockville General, have experienced financial difficulties and have recently reduced service offerings. With the $86.1M purchase, Hartford HealthCare will operate or be an affiliate of nine hospitals in Connecticut. Separately, a deal between Prospect Medical Holdings and Yale New Haven Health to purchase all three hospitals officially dissolved. Yale agreed to a $45M settlement over the failed sale of Waterbury, Rockville General, and Manchester Memorial Hospitals in 2022 (Connecticut Hospital Association, October 20).
Minnesota Medicare Advantage Plans to Drop Mayo Clinic from Networks
Starting on January 1, 2026, Mayo Clinic facilities in Minnesota, Wisconsin, and Iowa will no longer be in-network with several UnitedHealthcare and Humana plans. For patients enrolled under UnitedHealthcare’s Medicare Advantage and dual-eligible special needs plans, the Mayo Clinic will no longer be in-network. Individuals enrolled in group Medicare Advantage plans under United can still receive in-network services at Mayo Clinic. It remains unclear how many individuals under Humana plans will be impacted by the decision. However, a spokesperson from Humana indicated that the high cost of care at the Mayo Clinic led to their choice to exclude the provider from the network. According to a UnitedHealthcare spokesperson, patients with serious health conditions will be able to receive in-network care at the clinics for a limited period of time. After January 1, only two Medicare Advantage plans will offer Mayo Clinic services in-network, Blue Cross and Blue Shield of Minnesota and Medica (Modern Healthcare, October 17; The Minnesota Star Tribune, October 16).
Two Pennsylvania Health Networks Seeking Integrations
Two Pittsburgh-based health systems are expanding their footprints. Allegheny Health Network is set to acquire Heritage Valley Beaver and Heritage Valley Sewickley hospitals, upon government approval. Likewise, UPMC and CommonSpirit Health’s Trinity Health System have signed a non-binding letter of intent to merge. UPMC, which currently operates over 40 hospitals, will be entering the Ohio market for the first time through CommonSpirit (Healthcare Dive, October 16; Becker’s Hospital Review, October 16).
SPAs and Waivers
There were no new SPA or waiver approvals or submissions this week.
