With the midterms a month away, healthcare has emerged as one of the clearest electoral battlegrounds—and predictions about which health issues will matter most are piling up. Affordability remains voters’ biggest concern, and candidates in both parties are increasingly asked to answer for their positions on drug costs, insurance coverage and public health priorities.

KFF’s new Health Tracking Poll finds healthcare costs tied with gas as voters’ top economic worry, with 82% saying it’s very or extremely important for candidates to discuss health costs. Democrats hold a 42% to 22% trust advantage on the issue.

Drug pricing. Most favored nation pricing remains one of the biggest wild cards in health policy. While the Trump administration continues to push the proposal, congressional Republicans have shown little appetite for advancing it. If Democrats gain power, drugmakers are asking whether their price-control objections will hold, since Democrats could team up with the administration and activist-leaning Republicans.

Medicaid cuts. Hospitals are mounting a long-shot push to blunt last year’s cuts, but the immediate outlook remains challenging given the prospect of a Trump veto. Even so, the issue is becoming a campaign flashpoint in several competitive races, including Ohio’s Senate race and Arizona’s 6th District.

Medicare for All. Michigan’s Senate race could become a key test of Medicare for All’s political durability, with Democratic candidate Abdul El-Sayed embracing the policy. A record 66% of the public supports it, but that falls when voters hear about potential downsides such as delays in care or tax increases.

MAHA priorities. Democrats are increasingly courting Make America Healthy Again voters, addressing food safety and toxins while sidestepping vaccine debates. However, affordability continues to dominate voter concerns, potentially limiting how much political oxygen remains for other health priorities.

The bottom line: Healthcare is the top issue in Senate candidates’ ads and second to taxes in House ads. But as candidates make their health policy pitches, the races may ultimately be decided less by ideology than by what voters believe will lower their costs.

– Megan Hickey, Managing Director

Within a matter of days, the French government promised higher prices for innovative drugs, then tabled a budget asking for some of the biggest price cuts to existing drugs to date.

On September 28, France’s medicine pricing committee and four industry bodies signed a four-year framework agreement covering medicines prices from launch to loss of exclusivity. This replaced a 2021 text that guaranteed stable prices for three to five years after launch.

The new framework grants temporarily higher launch prices for innovative treatments in exchange for pricing reviews after three to four years and renegotiations every two years. It also rewards European production, supply security and pivotal trials enrolling at least 5% of patients in French research centres.

The press framed the news as an attempt to improve access to innovative treatments amid changing global drug-pricing dynamics. It also highlighted how the new measures could address the need identified by an industry-led consultation which found that 58.8% of healthcare professionals thought access to medicines was slower in France than elsewhere in Europe.

Industry signatories on the other hand were more cautious. Leem, the pharma industry association, reserved judgement pending implementation, while MedFrance said the new deal fell short of the changes needed to ensure the long-term viability of established medicines already widely available to patients.

The policy picture grew more complex only a few days later. On October 1, the government proposed a 2027 social security financing bill targeting €5.1 billion in savings, with a potential negative impact of €3 billion on the health sector alone through drug price cuts and a tax clawback mechanism. It also introduced a proposal for a new “golden rule” requiring the French health technology assessment authority to review reimbursed drugs annually and potentially withdraw those offering limited benefit—thereby helping to fund €16 billion of innovative treatments.

The French parliament will begin to examine the bill on October 12. Without a parliamentary majority, the debate will truly test whether France can reconcile its promise to reward pharmaceutical innovation with mounting pressure to cut the medicines bill.

– Francesca Boldrini and Marie Montant, Real Chemistry

Last week, HRSA approved 10 manufacturers and 23 medicines for its revised 340B rebate pilot program, which will begin on January 1, 2027.

The pilot, which HRSA is implementing to “improve transparency and program integrity,” aims to rein in a 340B program which has ballooned into a complex and opaque behemoth over the last 15 years. It allows manufacturers to switch their price reduction model for safety-net providers from upfront 340B discounts to back-end rebates.

The pilot was built to cover 25 drugs that have IRA-negotiated maximum fair prices beginning in 2026 and 2027. However, two drugs eligible for the rebate pilot—Calquence, AstraZeneca’s blood cancer drug, and Ozempic, Novo’s diabetes and obesity GLP-1 —will not be included following reported concerns that “pushback from the program’s covered entities and downstream partners could jeopardize sales in competitive markets.”

This is HRSA’s second attempt at a pilot; a similar proposal was struck down following legal challenges in January. Industry has been largely supportive of the pilot, with PhRMA calling it “a meaningful step” toward improving 340B program integrity.

Healthcare providers and hospital groups like the American Hospital Association slammed the pilot, claiming it will impose an unsustainable administrative and financial burden on already-strapped hospital systems and health centers. Just today, the AHA and others filed another lawsuit to halt the pilot, and a bipartisan effort in Congress may act to delay the pilot through 2028.

– Rachel Bridges, Senior Director

• Oct. 11-13 – annual strategic forum for global health, World Health Summit
• Oct. 14-15 – flagship convening of newsmakers in health and medicine, STAT Summit

• ““Some Medicare patients owe more in coinsurance than the hospital paid for their drug. That arithmetic sounds impossible. It is a consequence of the 340B drug discount program and Medicare’s payment formula” – HHS Chief Economist and Chief Regulatory Officer Casey B. Mulligan, STAT
• “Previously negotiated Medicare drug prices have quietly become inputs to new negotiations. Each cycle that inherits a prior price moves the program further from any explicit account of what a drug is worth” – Sean D. Sullivan et al., Health Affairs Forefront
• “As lower-cost Chinese drugs reach reference markets, they will depress the prices that MFN imports into the U.S. Pushed to its limits, MFN would let Chinese drug developers, which accept margins U.S. investors won’t, set the ceiling on U.S. drug prices. That would be an ironic outcome for a government pushing America-first policies” – Steve Usdin, BioCentury

• PhRMA filed suit against the White House on Wednesday, arguing CMS exceeded its authority by finalizing the GLOBE model. Fierce Pharma: PhRMA launches new legal challenge as CMS brings ‘most favored nation’ pricing to Medicare Part B.
• Despite all 50 states agreeing to participate in Medicaid’s GENEROUS model, just one state is confirmed to have signed a rebate agreement. Pink Sheet: Many States Joined Medicaid GENEROUS Model To Access Price Data, Not Sign Rebate Deals.
• Smaller biotech companies say they are struggling to navigate the Trump administration’s newest pharmaceutical tariffs. STAT: Biotech companies are struggling to navigate Trump’s new tariffs.
• The latest PDUFA agreement includes dedicated funding to help FDA restore reviewer staffing levels following agency attrition and layoffs. Endpoints: New PDUFA deal allots money to rehire FDA reviewers, trade groups say.
• By next May, HHS plans to publish a standardized format for health plans to disclose negotiated prescription drug prices. Inside Health Policy: HHS To Develop Drug Price Transparency Schema With May 2027 Publication Target.
• The FDA’s new transparency roadmap proposes public disclosure of drug applications upon filing and broader access to inspection reports, drawing support from former agency officials. Regulatory Focus: Experts weigh in on FDA’s transparency roadmap.
• A little-known advocacy group, the Pharmaceutical Reform Alliance, is gaining visibility in Washington through drug pricing research and polling supporting MFN-style reforms. Endpoints: In DC, a secretive new thorn has appeared in the pharma industry’s side.