Summary
Happy New Year! The Senate is in session today, while the House will return tomorrow, and the primary focus will be addressing the fiscal year (FY) 2026 appropriations before the January 30th continuing resolution (CR) deadline. The House is planning a vote on a minibus that would include funding for Commerce, Justice, and Science, Interior and the Environment and Energy and Water. However, with nine out of twelve appropriations bills to go, it is likely that Congress will pursue an additional CR until March or April to complete the appropriations process.
While the enhanced premium tax credits (EPTCs) expired on December 31, 2025, House Democrats will force a vote on their discharge petition to extend the EPTCs for three years on Wednesday. Senate Majority Leader John Thune (R-SD) has indicated that the bill would be dead on arrival in the Senate, if passed. However, if moderate Republicans continue to push the issue, we may see continued work on some version of the modified EPTCs.
340B Rebate Model Pilot Program Paused
On December 31, the U.S. District Court of Maine issued a temporary restraining order (TRO) to pause the implementation of the 340B Rebate Model Pilot Program. The Health Resources and Services Administration has indicated that manufacturers who were approved for participation in the pilot program will now be required to continue to offer all covered outpatient drugs to 340B covered entities at the 340B ceiling price as an upfront discount.
IDR Entity Fees for 2026
The Departments of Health, Labor, and the Treasury announced the independent dispute resolution (IDR) entity fees for 2026, which will remain unchanged from 2025. The administrative fee amount is $115 per party per dispute, and the certified IDR entity fee ranges are $200-$840 for single determinations and $268-$1,173 for batched determinations.
Regulatory Update
During the holiday break, the following rules were released, and Impact Health will release summaries shortly:
- Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications; and
- The Health Data, Technology, and Interoperability: ASTP/ONC Deregulatory Actions to Unleash Prosperity (HTI-5) proposed rule.
The Office of Management and Budget (OMB) is currently reviewing the following rules:
- ACA Marketplace: The HHS Notice of Benefit and Payment Parameters for 2027 proposed rule
- Medicare:
- Procurement of Domestic PPE. An advance notice of proposed rulemaking that would detail program incentives and requirements for Medicare providers and suppliers to invest and phase-in the procurement of American made personal protective equipment (PPE) and essential medicine to secure our nation’s health and safety.
- MA and Part D: Advance Notice of Methodological Changes for Calendar Year (CY) 2027 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies
- Medicaid:
- State Directed Payments. A proposed rule titled, “Medicaid Managed Care-State Directed Payments.” The proposed rule appears intended to advance a presidential memorandum released on June 6, which directs HHS to “eliminate waste, fraud, and abuse in Medicaid, including by ensuring Medicaid payments rates are not higher than Medicare, to the extent permitted by applicable law.”
- Medicaid Tax Waivers. A proposed rule titled, “Preserving Medicaid Funding for Vulnerable Populations – Closing a Health Care-Related Tax Loophole.”
- Prescription Drugs:
- A proposed rule titled, “Improving Transparency into Pharmacy Benefit Manager Fee Disclosure” and a proposed rule addressing Transparency in Coverage requirements.
- Immigration:
- Unaccompanied Children. An interim final rule titled, “Unaccompanied Children Program Foundational Rule; Update to Include Proof of Identity and Income Verification Standards.”