D.C. at a Glance: Vizient’s policy & advocacy updates

Legislative update

• Prior to departing for the extended July 4 recess, two House committees with jurisdiction over healthcare held markups of legislation with critical importance to healthcare providers. On June 25, the Subcommittee on Health of the Energy and Commerce Committee examined 15 bills, including H.R. 9393, the Lower Costs, More Transparency Act of 2026 and H.R. 9390, the Prices on the Wall Act of 2026. H.R. 9393 would codify certain price transparency requirements and force hospitals to post, in a machine-readable file, information about the standard charges and prices for each item and service furnished by the hospital for each year, including a plain language description of each item or service. H.R. 9390 takes reporting even further, and would require hospitals, ASCs, laboratories and providers of imaging services to post on the walls of their facility the discounted cash price of certain CMS-specified shoppable services. Both bills easily advanced out of the subcommittee and are expected to be considered by the full committee, although timing is uncertain. On July 1, the House Ways and Means Committee held its own markup of several tax bills, including H.R. 9504, the Tax Exempt Hospital Transparency Act. The bill would significantly expand reporting obligations for nonprofit hospitals beyond the current Form 990 Schedule H requirements by requiring additional information from hospitals related to their community benefit spending and utilization of the 340B Drug Pricing Program. The bill also directs the Government Accountability Office (GAO) to report the estimated federal income tax liability of the 25 largest tax-exempt hospitals as if they were taxable entities. During the markup, Democrats raised concerns around increased administrative burden on providers without actually addressing healthcare affordability, while Republicans argued the bill would provide overdue accountability. Despite Democratic opposition, the bill passed the committee on a party-line vote. However, due to the partisan nature of this bill, it has a longer road ahead of it. There is general support in Congress for increased price transparency legislation, however, with few remaining working days in Washington before the midterm elections, efforts to pass such expansive legislation will be complicated.
• The 340B Drug Pricing Program also continues to be of interest to policymakers, with new, bipartisan legislation released on July 6, the Strengthening the Exercise of Controls and Upgrading Requirements for Efficiency in 340B Act. The bill would put significant new reporting requirements in place for hospitals around 340B utilization, payer mix, charity care, and the use of 340B savings. The bill also establishes a national 340B claims clearinghouse, expands the audit authority of the Health Resources and Services Administration (HRSA) and creates stricter child site eligibility standards. Though this bill is bipartisan, efforts to reform the 340B Drug Pricing Program continue to be challenging, making final passage unlikely, especially during an election year.

Regulatory policy & executive action

• On June 12, Vizient® submitted comments (Press Release) to the Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) on the 2026 Interoperability Standards and Prior Authorization for Drugs proposed rule (Fact Sheet) (Vizient Summary). In our comments, we express support for CMS's overall proposal to extend payer electronic prior authorization (ePA) requirements to drugs while recommending several modifications related to prior authorization processes to improve implementation and reduce provider burden. Specifically, we encouraged CMS to shorten PA decision timeframes, suggesting a 72-hour maximum turnaround for standard requests and a 24-hour maximum for expedited requests, to require more detailed denial explanations and appeal instructions and to expand PA transparency with drug-specific reporting and uniform reporting templates. We also asked CMS to clarify that the proposed ePA requirements will not unintentionally restrict coverage design, site-of-care arrangements or how a medication may be dispensed. Finally, we support for ONC's efforts to shift towards technology standards that will help streamline the PA workflow.
• On June 12, CMS issued a proposed rule (Fact Sheet) codifying certain policies related to the Medicare Drug Price Negotiation Program (MDPNP) for initial price applicability year (IPAY) 2029 and beyond. The rule largely proposes making policies that have previously existed in guidance into regulation, as CMS's authority to operate the program through guidance expires after IPAY 2028. In addition, beginning with IPAY 2029, CMS may select up to 20 Part B and/or Part D drugs each year for negotiation, consistent with the Inflation Reduction Act. In the Proposed Rule, CMS also aims to formally establish the negotiation process in regulation, codifying the process for submitting manufacturer data, evaluating comparative effectiveness evidence, exchanging offers and publishing the agreed-upon Maximum Fair Price (MFP), along with an explanation of how it was determined. CMS also proposes formal rules for when a drug becomes ineligible for negotiation because of generic or biosimilar competition and implements changes from the One Big Beautiful Bill Act to broaden the Orphan Drug Exclusion. To improve program integrity, CMS proposes a new policy that would prevent certain manufacturers of fixed combination drugs from avoiding negotiation by changing how the agency will identify single-source drugs. For the Maximum Fair Price Effectuation in future years, CMS intends to release draft guidance in Summer 2026 to implement policies related to manufacturer effectuation of the MFP in 2028 and intends to codify MFP effectuation policies for 2029 and future years through rulemaking in calendar year 2027. Vizient will be submitting comments on this Proposed Rule, which are due Aug. 17. Please direct feedback to Jenna Stern.
• On July 2, CMS released the calendar year (CY) 2027 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule (Fact Sheet). Vizient will be producing a summary in the coming days, which can be found on our website. For CY 2027, CMS proposes to increase payment rates under OPPS and the ASC Payment System by 2.4%, which is based on a market basket percentage increase of 3.2% reduced by a productivity adjustment of 0.8%. CMS estimates that total payments to OPPS and ASC providers for CY 2027 would be about $110.9 billion and $9.9 billion, respectively, an increase of about $9.5 billion and $520 million from CY 2026 payment levels. CMS continues to implement the statutory 2 percentage point reduction in payments for hospitals that fail to meet the hospital outpatient quality reporting requirements. Notably, CMS also proposes to increase the 340B remedy offset adjustment from -0.5% to -3%, effective January 1, 2027. For providers subject to the 340B remedy offset, CMS expects payments will be reduced by $2.3 billion in CY 2027. Among other changes, CMS proposes to continue to phase out the inpatient only (IPO) list by removing 637 services from the list, site-neutral payment policy for certain imaging without contrast services when provided at an off-campus provider-based department and a nearly 40% reduction to reimbursement for 340B-acquired drugs. Specifically, CMS proposes to pay for 340B-acquired drugs at average sales price (ASP) minus 33.4%, rather than the current default OPPS rate of ASP plus 6%. This proposal is estimated to reduce Original Medicare drug payment by $4.55 billion in the first year. In addition to these changes, to implement a provision from the Consolidated Appropriations Act of 2026, CMS proposes a process for providers with an off-campus outpatient department to obtain a National Provider Identifier and meet certain attestation requirements. The Proposed Rule also includes an RFI on ways to improve the standardization of hospital price transparency data. Vizient will be submitting comments on this Proposed Rule, which are due Aug. 31. Please direct feedback to Jenna Stern.

To learn more, contact the Vizient Public Policy and Government Relations team at (202) 354-2600.