The Trump administration has launched TrumpRx, which is intended to connect consumers with discounted prices on certain prescription drugs sold directly by pharmaceutical manufacturers. The platform does not sell or dispense medications and does not integrate with insurance coverage or government health programs; instead, it allows individuals to purchase medications by paying cash. Pricing is supported through a partnership with GoodRx. To use TrumpRx, individuals must be U.S. residents and must certify that they are not enrolled in Medicare, Medicaid, or other state or federally funded prescription drug programs. Users must also agree not to seek reimbursement from any insurance plan and not to apply purchases toward insurance deductibles or out-of-pocket maximums. The website lists a limited number of branded drugs from five manufacturers that have entered pricing agreements with the administration. Some discounts are time-limited and are based on manufacturers’ list prices, which may differ from the net prices paid by insurers or public programs after rebates and other price concessions.
Policy experts state that many insured individuals may already be able to obtain lower out-of-pocket costs through existing coverage, generic alternatives, or private discount programs, which may limit the platform’s overall effect on prescription drug affordability. Experts also note that TrumpRx does not appear to operate as a covered entity under the Health Insurance Portability and Accountability Act (HIPAA). As a result, health-related information entered on the site may not be subject to federal health privacy protections and may instead fall under a patchwork of federal consumer protection rules and state privacy laws. Additionally, questions remain regarding the program’s administration and legal framework, including agency oversight and prescription validation (Health Payer Specialist, February 6; Inside Health Policy, February 5; PoliticoPro, February 5).
Following ongoing litigation seeking to block the implementation of the HHS’ 340B Rebate Model Pilot Program, on February 5, the agency officially rescinded the program. Based on a Joint Motion for Vacatur and Remand filed by the HHS and plaintiff hospitals, if the agency elects to relaunch the 340B rebate program, they must restart with a new notice and application process. The agency would then solicit public comment either prior to or concurrently with the issuance of the new materials (Fierce Healthcare, February 6; Inside Health Policy, February 6).
On February 10, Senators Elizabeth Warren (D-MA) and Josh Hawley (R-MO) announced their co-sponsoring of “The Break Up Big Medicine Act,” which seeks to prohibit parent companies from owning both a medical provider or management services organization (MSO) and a Pharmacy Benefit Manager (PBM) or insurer. Parent companies of prescription drug or medical device wholesalers would also be prohibited from owning a medical provider or MSO. Any company in violation of these regulations will have one year to comply or will face stringent financial penalties (CBS, February 10; Warren, February 10).
On February 9, CMS released the 2027 Notice of Benefit and Payment Parameters for the 2027 plan year on the ACA Marketplace. In line with previous regulations from the Trump administration, the proposed rule aims to increase oversight while also expanding flexibilities and lowering costs. In 2027, CMS proposes to expand regulations on marketing practices for qualified health plans offered on the federal and state-based exchanges (SBE), as well as for agents, brokers, and web-brokers who assist consumers with enrollment. This includes prohibiting marketing that suggests consumers will qualify for a zero-dollar premium health plan.
CMS also proposes to implement a state exchange improper payment measurement (SEIPM) program in calendar year 2027 to measure any improper payments of the advance premium tax credits (APTCs) through SBEs. The agency proposes several new flexibilities for the exchanges, like allowing states with federally-facilitated exchanges (FFEs) to conduct their own provider access reviews, ECP certification review, or both. CMS also seeks to revise current network adequacy requirements. SBEs and SBEs using the federal platform (SBE-FP) would no longer have to establish and implement quantitative time and distance standards equivalent to FFE plans. Instead, states have the responsibility to ensure that plans offered through their exchanges provide sufficient choice for consumers. CMS will require that any state-mandated benefit would be considered “in addition to essential health benefits (EHB)” and not an EHB, resulting in the state having responsibility for the cost of these benefits for their enrollees.
CMS also seeks to reverse previous regulatory action and prohibit issuers from including adult dental services as an EHB. Other proposals sought by the agency to lower costs and increase consumer choice include allowing issuers to offer catastrophic plans, with the option for multiple consecutive terms up to 10 years; expanding the hardship exemption eligibility for individuals aged 30 and older who are ineligible for APTCs or cost-sharing reductions; permit low-deductible plans with higher maximum out-of-pocket limits; and repealing certain standardized plan requirements to provide issuers with increased flexibility when designing plans. CMS will accept public comment on the proposed rule through March 11 (CMS Newsroom, February 9; Federal Register, February 11).
A recent study published in JAMA Network Open found that women living in Medicaid expansion states were less likely to die from breast cancer. Researchers across three institutions reviewed the data of women aged 40 to 64 who were diagnosed with the disease between 2006 and 2021 and compared survival rates between women living in Medicaid expansion states and non-expansion states. The population reviewed in the study was inclusive of all insurance types. Medicaid expansion began around 2014; the study utilized early adopting states. Among the women in the dataset, 58% lived in expansion states and 42% in non-expansion states. The results showed that Medicaid expansion was associated with lower overall mortality for women across several variables including disease stage, race or ethnicity, or neighborhood income. Among different racial and ethnic groups, Hispanic women living with breast cancer had the largest difference, being 19% less likely to die if they lived in an expansion state. Non-Hispanic Black women were 4.3% less likely to die living in an expansion state. Non-Hispanic white women had the lowest difference between expansion and non-expansion states, at 3.4%. When comparing disease stage, women with metastatic breast cancer living in expansion states were 13.9% less likely to die. A coauthor of the paper noted that the results of the study suggest that healthcare coverage leads to greater access to treatment (Stateline, February 6).
Iowa will distribute more than $78.6M in federal funding to strengthen rural healthcare infrastructure and workforce capacity under its Healthy Hometowns initiative. The state received $209M in the first year of funding through CMS’s Rural Health Transformation Program and is the first state to begin distributing funds. Approximately $66M will support rural providers in expanding service lines through major equipment investments, including advanced imaging, robotic surgical systems, radiation therapy technology, and endoscopy platforms. An additional $12.6M will fund recruitment incentives to attract full-time physicians, advanced practice providers, nurses, and specialty clinicians to rural communities (Iowa, January 30).
Indiana has announced plans to reprocure its Medicaid managed care contracts worth approximately $68B, covering all major Medicaid programs and about 1.4 million residents. State officials indicated they plan to rebid the contracts, with new agreements expected to take effect in 2029, while details of the procurement are still under development. The decision follows the state’s November termination of a Medicaid contract with MDwise, which affected more than 300,000 enrollees and resulted in 238 layoffs. Enrollees were required to select coverage from remaining managed care plans, reflecting a change in Indiana’s Medicaid managed care arrangements (Health Payer Specialist, February 5).
On February 6, Idaho’s Joint Finance-Appropriations Committee (JFAC) voted to approve an additional 1% cut in FY2026, amounting to a $131M general fund (GF) reduction. This will be on top of Governor Little’s 3% state agency cut that was implemented last year. Following this decision, the JFAC also voted to implement a uniformly permanent 2% budget cut to most of the state’s departments, amounting to about $143M in GF reductions in FY2027. Carved-out of the second round of cuts are the Medicaid program, the Idaho State Police, the Department of Correction, and the K-12 public school system. There has been a bipartisan pushback in the Idaho Legislature following the approval of the cuts, with many legislators seeing JFAC’s approach as short-sighted and fails to consider the state’s long-term growth potential. The week prior, state agencies submitted a list with potential impacts the budget cuts could have on public services, including furloughs for state employees and increased physician workforce shortages. JFAC is set to vote on operation maintenance budgets on February 13 (Idaho Capital Sun, February 6).
