Health workers sound alarm on Trump loan caps

By Maya Goldman – A Trump administration plan to limit student loan borrowing for graduate education is drawing fire for excluding nurses, physician assistants and other types of health workers from higher loan caps. Why it matters: The Department of Education's classification plan could exacerbate medical workforce shortages by putting a more stringent limit on what students in certain advanced health provider programs can borrow from the federal government, professional groups say. Read Full Article...

HVBA Article Summary

1. New Loan Caps for Graduate Students: A new federal law takes effect July 1, capping student loan borrowing at $200,000 for “professional” programs and $100,000 for other graduate degrees. This poses a challenge for students in expensive programs, as medical school debt averages $236,000 and other health science doctorates average $299,000. The change also eliminates an existing federal loan program for graduate students.

2. Narrow Definition Excludes Key Health Roles: The administration’s proposed definition of “professional” includes doctors and pharmacists but excludes advanced nurses, PAs, and physical therapists. Critics argue this will limit access to vital health careers and worsen workforce shortages. A petition to expand the list has gathered over 224,000 signatures, and advocacy groups report tens of thousands of concerned inquiries.

3. Widespread Pushback and Uncertain Outcome: Lawmakers and public health organizations warn the rule could undermine crisis readiness and deepen healthcare staffing gaps. The Education Department says the rule is not final and may change based on public input. Meanwhile, the AAPA is prepared to pursue litigation if the exclusion list remains unchanged.

US, UK announce deal on pharmaceutical tariffs and drug pricing

By Ashleigh Furlong and Lucy White – The Trump administration has reached an agreement with the U.K. to allow tariff-free imports of pharmaceutical products in exchange for a significant reduction in rebates drugmakers pay to Britain's National Health Service. The U.S. agreed to "exempt U.K.-origin pharmaceuticals, pharmaceutical ingredients, and medical technology from Section 232 tariffs," the Office of the U.S. Trade Representative announced Monday. The U.S. will also "refrain from targeting U.K. pharmaceutical pricing practices" in certain trade investigations during President Donald Trump's term, according to the statement. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. New U.K.–U.S. Trade Terms Affect Pharmaceuticals: Although the U.S. and U.K. had established a broad trade framework earlier in the year, the treatment of specific sectors like pharmaceuticals remained unresolved. The newly announced deal addresses this gap by increasing the net price the U.K. pays for new medicines by 25%, signaling a shift in the economic terms for drug imports and exports between the two nations.

2. Rebate Reduction Eases Burden on Drugmakers: As part of the agreement, the rebate pharmaceutical companies pay on sales to the U.K.'s National Health Service (NHS) will be reduced from approximately 23% to a maximum of 15%. This change responds to industry criticism over the U.K.'s drug pricing model, particularly the VPAG scheme, which has been seen by drugmakers as disproportionately burdensome compared to other European markets.

3. U.S. Trade Policy Pressures Foreign Pricing Models: The U.S. is increasingly using trade mechanisms—namely Sections 232 and 301 of the Trade Act—to exert pressure on other countries’ drug pricing systems. These tools are intended to promote domestic pharmaceutical production and secure more favorable pricing for American consumers, reflecting a broader strategy to reshape global pharmaceutical trade dynamics.

CMMI debuts ACCESS Model to spur use of tech in chronic disease treatment

By Emma Beavins – The CMS Innovation Center has debuted a new model to encourage the use of technology to treat chronic diseases that could be a boon for health tech companies that have struggled with reimbursement. The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model is a 10-year payment program that would offer stable, recurrent payment for technology used to treat diabetes, hypertension, chronic kidney disease, obesity, depression and anxiety. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. ACCESS Model Enables Medicare Coverage for FDA-Cleared Health Technologies: The ACCESS Model expands Medicare coverage to include FDA-cleared digital health technologies, like prescription digital therapeutics, which were previously excluded due to statutory limitations. Coverage is contingent on the technology demonstrating improved patient outcomes, particularly for chronic conditions. This initiative aims to integrate innovation into Medicare and enhance care options for beneficiaries.

2. Outcomes-Based Payment and Incentives for Providers: The model ties payments to clinical outcomes rather than specific services, giving providers flexibility in how they deliver care. Referring providers can earn up to $100 per patient annually, and Medicare will waive co-pays for eligible services. These incentives support the use of technology and patient-centered care strategies.

3. Expanded Infrastructure and Tools to Support Adoption: CMS will provide a public directory and optional tools to help providers implement the model, including data-sharing systems and connected medical devices. Technology vendors may offer discounts to participants to encourage adoption. Medicare Part B providers can apply to join the model from 2026 through 2033.

Maine tells insurers they must honor referrals from any direct health care provider

By Allison Bell – State insurance regulators in Maine are trying to help patients mix and match out-of-network providers with their health plans' in-network providers. Robert Carey, the superintendent of the Maine Bureau of Insurance, has issued a bulletin telling health plans that a plan must open up its provider network gates when any care provider wants to refer an enrollee to an in-network specialist or other in-network care provider. Read Full Article...  ^{_{(Subscription required)}}

HVBA Article Summary

1. Expansion of Referral Rights in Maine: Since 2019, Maine has required that out-of-network direct primary care providers be allowed to refer patients to in-network services without penalties. A new law expands this right to include all direct health care providers—including any licensed physicians or independently practicing advanced health care practitioners in the state—ensuring broader referral authority regardless of network participation.

2. Limitations on Insurer Restrictions: Under the new law, insurers cannot deny referrals or impose extra cost-sharing solely because the referring provider is out-of-network or practices direct care. However, insurers may still apply their standard cost-sharing terms, benefit caps, and clinical review criteria as they would for referrals made by in-network providers.

3. Broader Policy Implications and Industry Tensions: While patients and advocates may view this law as enhancing access and protection, employers and plan administrators may see it as a challenge to cost-control efforts like provider network management and wellness programs. This policy shift reflects broader national tensions, including debates over out-of-network reimbursement, prior authorization practices, and health plan strategies to manage medical costs.

GLP-1s go from niche to mainstream

By Adriel Bettelheim – New pricing deals and aggressive marketing are transforming expensive GLP-1 weight-loss drugs into mainstream treatments and creating the next mega-market for the pharmaceutical industry. Why it matters: Americans have shown they're willing to pay thousands of dollars out of pocket for the treatments — making them more popular than ever even as insurers try to pump the brakes by restricting coverage. Read Full Article...

HVBA Article Summary

1. GLP-1 Usage and Access Are Expanding Amid Rising Demand and Cost Concerns: One in eight Americans report currently taking a GLP-1 drug like Ozempic or Wegovy, primarily for weight loss or chronic conditions. While most have some insurance coverage, 27% pay the full cost out-of-pocket. Usage channels vary, with 75% obtaining GLP-1s through their doctors and 17% via online providers. Drugmakers Eli Lilly and Novo Nordisk recently cut prices as part of a deal with President Trump to expand Medicare access. They also plan to sell directly to employers starting next year, possibly altering workplace insurance models. In one case, an employer used a debit card to subsidize 50% of the cost via direct-to-consumer websites.

2. GLP-1 Drugs Are Evolving, but Side Effects and Clinical Setbacks Persist: Although pill versions like Novo’s Rybelsus aim to eliminate injections and reduce logistical barriers, unpleasant side effects — such as nausea, vomiting, and diarrhea — frequently cause users to stop treatment, often leading to weight regain. Many start these medications without proper counseling on lifestyle changes. Meanwhile, research into GLP-1s’ use for conditions like addiction, COPD, dementia, and Parkinson’s disease continues. However, not all trials are successful — for example, Rybelsus recently failed to delay Alzheimer’s progression in two clinical studies.

3. Pharmaceutical and Market Momentum Signals GLP-1s’ Mainstream Potential: The economic and strategic stakes surrounding GLP-1s are growing rapidly. Eli Lilly’s market value reached $1 trillion last week, fueled by the launch of its GLP-1 drug Zepbound two years ago. Competitive pressure is intensifying, as shown by Pfizer’s $10 billion bid for obesity drugmaker Metsera, beating out Novo Nordisk. Experts suggest that easier-to-produce pill versions may lower costs and improve insurance coverage. Still, researchers stress the need for more studies to understand how GLP-1s work in the brain and influence reward pathways, especially as new medical applications emerge.

Pharmacies will be the canary in the coal mine on the Medicare drug price negotiations

By Sujith Ramachandran - The Centers for Medicare and Medicaid Services recently announced negotiated prices for 15 drugs, finalizing the second iteration of the Medicare Drug Price Negotiation Program. The first set of negotiated drug prices will go into effect in January 2026. Despite months of building the infrastructure and policies governing the program, stakeholders are unsure whether the implementation plan will deliver guaranteed access and adequate reimbursement for the negotiated drugs. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Medicare Drug Price Negotiation Promises Significant Savings but Brings Complex Implementation Challenges: The CMS negotiation program is projected to save billions on prescription drug costs, but it is also an unprecedented and intricate initiative. Its wide-reaching effects, including new payment models and manufacturer refunds, are not yet fully understood by many in the healthcare sector. There are concerns about how these changes will impact the financial and operational stability of pharmacies, particularly smaller or independent ones.

2. Pharmacies and Providers Fear Delayed or Insufficient Reimbursements Could Disrupt Drug Access: Stakeholders, including pharmacy organizations and patient advocates, worry that the new reimbursement structure may lead to pharmacies refusing to stock or dispense negotiated drugs due to cash-flow concerns. Delays or shortfalls in manufacturer-issued refunds could disproportionately affect independent pharmacies, possibly leading to closures or reduced services—especially in rural or underserved areas.

3. CMS Must Strengthen Monitoring to Prevent Unintended Consequences and Ensure Program Success: While CMS has issued guidance and introduced support mechanisms, there are still gaps—particularly around monitoring how insurers (Part D plans) implement negotiated drug coverage. Without timely oversight of dispensing data, formulary placement, and pharmacy closures, the program risks harming patients and failing to deliver the anticipated Medicare savings. Ongoing monitoring and collaboration with stakeholders are essential for early issue detection and policy adjustments.

Smartphones at age 12 linked to worse health

By Maya Goldman - Preteens who own smartphones are likelier to have depression, obesity and insufficient sleep than their peers, according to a new University of Pennsylvania-led study. Why it matters: Roughly half of American kids now own a smartphone by the time they turn 11. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Smartphone Ownership Linked to Health Risks in Youth: According to a large-scale study involving over 10,000 youths, children who owned smartphones at age 12 had significantly higher odds of experiencing depression (31%), obesity (40%), and insufficient sleep (62%) compared to peers without smartphones. These associations remained even after controlling for ownership of other digital devices like tablets and smartwatches.

2. Demographic Trends in Early Smartphone Ownership: The data indicated that early smartphone ownership was more prevalent among children who were female, Black or Hispanic, and from lower-income households, highlighting potential socioeconomic and demographic patterns in technology access and use.

3. Calls for Parental Oversight and Further Guidelines: While pediatric health groups have addressed screen time, no formal public health guidelines currently exist regarding the appropriate age for smartphone ownership. The study suggests that, like nutrition and social environments, smartphones require active management and oversight from caregivers to mitigate potential risks.