This Week (November 10-14)

The House and Senate are both scheduled to be in recess this week for Veterans Day. However, it's possible the chambers could convene if there is movement on a Senate-amended deal.

Last Week (November 3-7)

Congressional Highlights

U.S. government shutdown continues. This week has been viewed as a key pressure point for reopening the federal government, with the ACA exchange open enrollment launching November 1, federal SNAP funding running out, off-year elections on November 4, and an order from the Federal Aviation Administration to reduce daily domestic flights at 40 airports. Senate Majority Leader John Thune (R-SD) signaled the potential for a deal that included:

• a vote on the enhanced ACA subsidies, or, perhaps, the promise of a vote by a certain date
• a new, longer CR until late 2025 or early 2026 (the current House-passed CR expires November 21)
• passage of the Military Construction-Veterans Affairs, Agriculture (which includes the Food and Drug Administration), and Legislative Branch minibus appropriations package.

However, after Democrats' success in Tuesday's elections, Democrats have doubled down on their demand to attach a one-year extension of the enhanced ACA subsidies to the CR. As of publishing, the Senate is still expected to hold votes on Friday, but the details and potential outcome remain unclear. Republicans would need about five Democrats to vote to reopen the government.

President Trump has largely stayed out of the shutdown discussions but has repeatedly called for Republicans to override the filibuster for appropriations to allow the CR to pass on a simple majority vote.

Democrats voice concern with health care costs. On Tuesday (November 4) a group of 28 Senate Democrats sent a letter to HHS Secretary Robert F. Kennedy Jr. in which they write the Administration has failed to address rising health care costs.

Administrative Highlights

CMS issues CY 2026 MPFS final rule. On Friday (October 31), the Centers for Medicare & Medicaid Services (CMS) issued their Calendar Year (CY) 2026 Medicare Physician Fee Schedule (MPFS) Final Rule, which includes updates to Medicare Part B payments and policies, the Medicare Shared Savings Program (MSSP), the Inflation Reduction Act (IRA) rebate models, and more. CMS in the rule finalized conversion factor increases of 3.77% and 3.26% for qualifying participants and non-qualifying participants, respectively. However, the rule includes several updates to the methodology for determining the physician fee schedule that will limit the positive update for certain specialties. Click here for a fact sheet of the final rule and click here for a fact sheet on the Medicare Shared Savings Program.

• For our full coverage see the attached WCEY Alert: Medicare Physician Fee Schedule Final Rule CY 2026.

Trump Admin announces GLP-1 MFN deals. On Thursday (November 6), the Trump Administration announced Most Favored Nations deals with Eli Lilly and Novo Nordisk to lower the cost of their products, including GLP-1s, and increase their investment in U.S. manufacturing and R&D in exchange for expanded market access for GLP-1's, protection from future tariffs and priority review of their new GLP-1 products. The deals, which largely follow the format of those with Pfizer, AstraZeneca, and EMD Soreno, include:

• Direct access for patients. Under the deal, Eli Lilly and Novo Nordisk will sell their primary care drugs at discounted on Trump RX before the end of the year. In addition, their GLP-1's will be available at $350 per month. Any new GLP-1's approved by the FDA will be available at $150 per month.
• MFN pricing for Medicaid. Eli Lilly and Novo Nordisk have agreed to provide all of their other medications to Medicaid at MFN prices and state Medicaid programs will have access to GLP-1's for $245.
• Future proofing fairness. Eli Lilly and Novo Nordisk committed to launching all future drugs at MFN prices across commercial, Medicaid, Medicare and the cash pay markets.
• Shared savings. The companies and the U.S. also committed to deploying savings from existing drugs in Europe back to the U.S.
• Onshoring: As part of the deals, Eli Lilly agreed to invest $27 billion in domestic manufacturing, while Novo Nordisk will invest $10 billion in U.S.-based facilities.

In exchange, the companies received National Priority Review Vouchers for their new obesity products, Orforglipron and Wegovy. In press releases, Eli Lilly and Novo Nordisk both said they also received three years of tariff relief.

In addition, the companies said they will sell their GLP-1s to Medicare for $245, in exchange for Medicare covering the products for weight loss, which current statute prohibits. Medicare beneficiaries will pay a $50 co-pay for the products. Novo Nordisk in its press release confirmed that the Part D coverage will be enabled through a yet to be announced pilot program. Eli Lilly in its release said Medicare beneficiaries will be able to access the products as early as April 1, 2026, but it is unclear the exact parameters.

It is also unclear as of now how the MFN deals will impact the Inflation Reduction Act's drug price negotiation program. Novo Nordisk's Wegovy and Ozempic were subject to negotiations this year, and while the company has confirmed negotiations have concluded, the final maximum fair prices have not been published. The Trump Administration told reporters on Thursday (November 7) that the MFN prices were negotiated separately from the IRA's process.

FDA awards new national priority review vouchers. On Thursday (November 6), the FDA announced six new products from Boehringer Ingelheim, Johnson & Johnson, GSK, Vertex, Novo Nordisk and Eli Lilly that received national priority review vouchers.

CMMI unveils new MFN-style model. On Thursday (November 6), the CMS Innovation Center unveiled a new voluntary model called GENEROUS (GENErating cost Reductions for U.S. Medicaid) set to run from January 2026 to December 2030. The five-year model is designed to lower state Medicaid costs for certain covered outpatient drugs through CMS-led price negotiations with drug manufacturers. Under the program, participating manufacturers would provide supplemental rebates to participating state Medicaid programs to align drug prices with those of select countries (the "MFN" price). CMS issued a Request for Applications (RFA) for manufacturers interested in participating in the model and will seek letters of intent from state Medicaid agencies interested in participating in the model. States can apply on a rolling basis through August 31.

CMS issues guidance on Medicaid enrollment in multiple states. On Thursday (November 6), CMS issued guidance that states an average of 1.2 million individuals were enrolled in more than one state's Medicaid program or Children's Health Insurance Program each month in 2024. CMS reiterated current state requirements to ensure that individuals are only enrolled in the state where they reside and reminded states of upcoming new requirements under the One Big Beautiful Bill Act, adding that it will soon provide each state with a file on the beneficiaries potentially enrolled in another state.

Rural Health Transformation Program applications close. The deadline for states to apply to the rural health transformation program was Wednesday (November 5), and CMS Administrator Mehmet Oz confirmed that all states have applied for the funding. CMS said it is still on track to meet the December 31 deadline to announced award decisions.

Legal Highlights

Supreme Court hears challenges to IEEPA tariffs. On Wednesday (November 5), the Supreme Court heard oral argument in three cases concerning whether the International Emergency Economic Powers Act (IEEPA) authorizes the President to impose tariffs to address a national emergency. During oral argument, a majority of the Justices expressed skepticism of the Government's case that the statutory authority under IEEPA to "regulate importation" extends to imposing tariffs. While the timing of a decision is unclear, the expedited process for the case thus far could prompt the Court to issue a decision before the end of 2025.

Following the arguments, USTR Jamieson Greer suggested the administration has other ways to keep its tariffs in place if the Supreme Court knocks down the ones Trump has imposed under the IEEPA, but he declined to discuss them in detail. Trump was similarly tight-lipped at the White House on Thursday, but he did acknowledge the need for a backup plan. "I think it would be devastating for our country [if the administration loses], but I also think we'll have to develop a Game Two plan," Trump told reporters at the White House. "We can do other things, but they are slow by comparison." Click here for WCEY's full alert.

AAP calls for ACIP member dismissal. On Wednesday (November 5), the American Academy of Pediatrics and other organizations amended their lawsuit against HHS Secretary Robert F. Kennedy Jr. to request the judge rule that the newly appointed members of the Advisory Committee on Immunization Practices (ACIP) be dismissed and reconstituted under court supervision.

SNAP funding. A district court judge in Rhode Island this week issued a ruling requiring the federal government to fully pay SNAP benefits for November. The USDA has appealed the decision, saying it only has available funding to cover about 65% of November's benefits.

Hearings, Markups, and Other Committee Activity

Homeland Security & Governmental Affairs Permanent Subcommittee on Investigations held a hearing on "Assessing the Damage Done by Obamacare." On Thursday (November 6), the Subcommittee heard testimony from a panel of witnesses representing advocacy groups, think tanks, and small businesses. During the hearing, Republicans spoke critically of the ACA with some members favoring implementing high-risk pools, while Democrats spoke in defense of the ACA and the need to extend the ACA's enhanced subsidies.

• More information available here.

Senate Special Committee on Aging will hold a hearing on "Renewing Our Commitment: How the Older Americans Act (OAA) Uplifts Families Living with Aging-Related Diseases." On Wednesday (November 5), the Committee heard testimony from individuals representing family caregivers and patient advocates on the OAA, which authorizes federal grants to help states provide community social services to older adults. During the hearing, witnesses and many members spoke of the need to reauthorize the OAA for FY 2026, with Republicans asking questions on potential changes to better serve recipients.

• More information available here.

Reports, Studies, and Journals

• Health Affairs: Children's Medicaid Enrollment Increased During First Year Of Consolidated Appropriations Act. The study found states without prior 12-month continuous Medicaid eligibility for children up to age nineteen showed larger gains in children's enrollment than states with prior continuous eligibility after a provision in the Consolidated Appropriations Act, 2023 was implemented.
• Committee for a Responsible Federal Budget: Fixing Medicare Physician Payments. The article provides an overview of several options to reform the Medicare Physician Fee Schedule, including by better accounting for physicians' efficiency gains in performing procedures and using technology, systematically revaluing codes as their relative values change, and improving tracking of advanced practice providers.