The cost of health care remains front and center in Congress, as it remains a top worry for American voters ahead of the U.S. midterm elections.

On Thursday, the Senate HELP Committee, led by Chair Bill Cassidy, R-La., and Ranking Member Bernie Sanders, I-Vt., held a hearing on lowering drug costs. It covered a range of topics from the effectiveness of President Trump’s MFN deals to the 340B program, from PBM reform to the availability of generics and biosimilars.

Ahead of the hearing, both Cassidy and Sanders released agenda-setting publications intended to address the current state of health care.

Sen. Cassidy unveiled the “Money and Value for Patients (MVP)” agenda, which vaguely proposed measures to improve affordability, including giving money directly to patients to help cover their out-of-pocket costs and improving price transparency. The agenda also calls for the expansion of TrumpRx.

Meanwhile, Sen. Sanders published a report asserting that manufacturers are increasing drug prices despite Trump’s MFN dealmaking. Critics of the report note that this is a narrow analysis looking solely at list prices rather than the net prices consumers are actually paying.

While typical partisan division was on display this week, one clear unifying call to action emerged: Increased transparency is urgently needed to ensure programs are working on behalf of the American people to bring down health care costs.

– Rachel Bridges, Senior Director

(Editor’s Note: Next week’s Value Report will feature a full rundown of the seven scheduled budget hearings featuring HHS Secretary Kennedy.)

Picking up where we left off last Friday, CMS proposed a sweeping overhaul of prior authorization for prescription drugs, setting strict new deadlines of 24 hours for urgent requests and 72 hours for standard approvals across Medicare Advantage, Medicaid, CHIP and ACA exchange plans.

In addition to new time limits, insurers will be required to publicly report drug-related prior authorization metrics, including approval and denial rates, appeal outcomes and decision timelines. This builds on a 2024 regulation to streamline prior authorization processes, as well as payers’ 2025 voluntary commitments to reduce prior authorization for common medical procedures.

The rule arrives amid years of growing pressure on pharmacy benefit managers, exacerbated by a rule recently proposed by the Department of Labor to increase PBM fee transparency. The Pharmaceutical Care Management Association is calling to rescind on the grounds it is ”duplicative” of PBM reform legislation already signed into federal law, further burdening smaller PBMs and reducing market competition.

But employers aren’t waiting for Washington. According to a new Purchaser Business Group on Health survey, 37% of major employers are now shopping for new insurance providers – up from just 12% in 2024 – with a growing number turning to transparent, flat-fee PBMs to cut costs and reclaim control.

– Megan Hickey, Managing Director

A handful of prescription drug affordability boards across the U.S. are inching toward state-level price caps, with Maryland’s board seeking to become the second state to apply an upper payment limit on a medicine.

On Monday, Maryland’s first-in-the-nation PDAB voted to move forward with price limits on Jardiance, a diabetes drug from Eli Lilly and Boehringer Ingelheim. The price ceiling would take effect among state and local government health plans in 2027, with the expected cost benchmarked against the maximum fair price paid by Medicare.

The board has opened a 30-day public comment period before a final vote is held. The move was praised by advocates but is triggering pushback from the pharma industry, among others.

Maryland’s neighbors to the south are still trying to get its board off the ground. Virginia Governor Abigail Spanberger sent a PDAB bill passed in March back to the state’s General Assembly with suggested amendments. Advocates are pushing for legislators to override the changes, which are related to language mirroring the federal Inflation Reduction Act.

All the rage among legislatures just a few years ago, the pursuit of PDABs has cooled as states now reckon with budget strain and splits with the federal government on public health. To help mitigate drug costs, state policymakers – and attorneys – are increasingly focused on measures to rein in PBM practices and reform the 340B program.

– Andrew Wishon, Editor-in-Chief

• April 21 – Kennedy testifies at HHS budget hearings, House Energy & Commerce / Senate Appropriations
• April 22 – Kennedy testifies at HHS budget hearings, Senate Finance / Senate HELP
• April 22 – committee hearing on the PBM business model, House Education & Workforce
• April 23 – public meeting on increasing access to nonprescription drugs, FDA

• “Some 8,500 Americans die every year of melanoma, many of whom could be saved by Replimune’s RP1. But Dr. Prasad and Commissioner Marty Makary have decided that for whatever reason they aren’t worth saving.” – Editorial Board, The Wall Street Journal
• “The uninsured is not the most politically salient problem in health care now – that’s affordability – nor is it the non-problem some say it is. But it’s coming back. And the problem of the chronically ill uninsured is glaring.” – Drew Altman, KFF
• “Surviving into adulthood should not mean being excluded from hopeful therapies. Like so many others, my brother does not have decades to wait for additional clinical trials with the potential for an expanded FDA label.” – Nathan Grant, STAT

• Kennedy used his first two House hearings of 2026 to stress affordability and anti-fraud efforts while mostly sidestepping hot-button issues. STAT: Kennedy focuses on affordability, combating fraud in Capitol Hill hearings.
• Trump nominated former Deputy Surgeon General Erica Schwartz to lead the CDC after the post sat effectively vacant for several months. The Hill: Trump picks former Deputy Surgeon General Erica Schwartz as new CDC nominee.
• A Bayer executive said Trump’s MFN pricing policy will likely narrow the drug price gap between the U.S. and Europe, even though the company was not part of the administration’s first round of pricing talks. Endpoints News: Bayer pharma executive predicts US-Europe price spreads will narrow.
• The FDA is closing in on a new biologics and vaccines chief, with controversial biotech executive and ophthalmologist Houman Hemmati emerging as a leading candidate. Endpoints News: Exclusive: FDA narrows in on search for new biologics and vaccines leader.
• Pharma heads into Q1 earnings season on firmer footing with M&A back in focus and policy pressures easing, though analysts still expect questions on tariffs, FDA turnover and obesity pricing. BioSpace: On steadier ground, pharma heads into Q1 earnings with deals top of mind.
• Merck and Sanofi are the latest drugmakers to join TrumpRx, bringing the total number of participants on the government discount website to 13. Fox Business: Merck, Sanofi are latest companies to add medications to TrumpRx.
• The FDA’s policy of publishing complete response letters is making biopharma companies more candid about why their drugs were rejected, though redactions leave gaps in the public record. BioSpace: FDA’s CRL transparency policy is boosting biopharma accountability.
• After winning the prestigious 2026 Drug Name Tournament, Ionis said its RNA-targeted injection Dawnzera was designed to signal “a dawn of a new era” for patients with hereditary angioedema. Fierce Pharma: Ionis exec shares method to the Madness after 2026 Drug Name Tournament win.