Prescription Drug Pricing Update: Society Continues Advocacy to Lower Price and Out-of-Pocket Costs of Medications
Last month, the Trump Administration and a major retailer took steps to address high prescription drug prices. On September 30, the Trump Administration announced the creation of “TrumpRx,” a consumer website where Americans can buy medications at a discounted price. The president also announced deals with two major drug manufacturers, Pfizer and AstraZeneca, to reduce the prices of many of their products. The President left the door open to possible deals with other drug makers in the future.
Meanwhile, one of the nation’s largest retail wholesalers took steps last month to make GLP-1 medications more affordable for people without insurance. Costco announced that it would begin selling Ozempic and Wegovy at a discounted price of $499 for a four-week supply. This reduced price will only be available for people without insurance. There continues to be major barriers to accessing GLP-1 medications. Medicare is prohibited from covering these medications for weight loss and because of this restriction many private insurers also do not cover them.
Lowering the price of prescription drugs continues to be a major priority for the Endocrine Society and we will continue to closely monitor these developments in the coming weeks. We will also continue to advocate for Congress to lower the price and out-of-pocket cost of prescription drugs. The Society has been a leader in advocating for insulin affordability and has urged Congress to expand the $35 monthly co-pay cap on insulin, currently available for Medicare beneficiaries, to the commercial insurance market.
The Society has also advocated for expanding access to anti-obesity medications (AOM). We support the Treat and Reduce Obesity Act (TROA) which would allow Medicare to cover AOMs for weight loss. TROA was recently re-introduced in Congress, and we have been urging lawmakers to co-sponsor this important legislation. We encourage Endocrine Society members to take action on our TROA campaign by contacting your members of Congress urging them to co-sponsor TROA. Please visit endocrine.org/takeaction to join our campaign.
Federal Government Shutdown Disrupts Research and Clinical Care
On October 1, funding for the federal government expired because Congress failed to pass a continuing resolution (CR) to fund the federal government. As this issue of Endocrine News goes to press, the shutdown impasse continued and it appeared the shutdown could run into November. The lapse in funding is affecting Endocrine Society researcher and clinician members. Below is information which will be helpful to you during the shutdown:
Taking Action to Resolve the Government Shutdown:
We urge you to join our new online advocacy campaign to tell your senators and representative to pass a full-year funding bill that reopens the government and to support funding the National Institutes of Health at least at the Senate Appropriations Committee’s bill level of $47.8 billion for FY 26. Please visit: www.endocrine.org/advocacy/take-action.
What Researchers Need to Know
As a result of the current shutdown of the federal government, operations at the NIH have shifted to maintain essential services at its biomedical research hospital, the NIH Clinical Center. The Department of Health and Human Services (HHS) released a contingency plan that details which NIH activities will not resume during the shutdown. These activities include:
- All NIH grant peer review meetings, advisory council meetings, issuance of new awards, and program/grants management activities.
- The admission of new patients to the NIH Clinical Center (unless deemed medically necessary by the NIH Clinical Center Director).
- Training of graduate students and postdoctoral fellows at NIH facilities.
- Travel of NIH scientists to scientific meetings.
NIH staff, whose responsibilities are deemed necessary for patient care and the protection of property, will continue to work without pay.
What Clinicians Need to Know
Medicare and Medicaid Programs: According to the Centers for Medicare & Medicaid Services (CMS) contingency plan, during a lapse in funding, the Medicare Program will continue. CMS has sufficient funding for Medicaid to fund the first quarter of FY 2026, based on the advanced appropriation provided for in the Full-Year Continuing Appropriations and Extensions Act, 2025. CMS is maintaining the staff necessary to make payments to eligible states for the Children’s Health Insurance Program (CHIP). CMS is also continuing Federal Marketplace activities, such as eligibility verification, using Federal Marketplace user fee carryover. Other non-discretionary activities including Health Care Fraud and Abuse Control (HCFAC) and Center for Medicare & Medicaid Innovation (CMMI) activities are also continuing.
Lowering the price of prescription drugs continues to be a major priority for the Endocrine Society and we will continue to closely monitor these developments in the coming weeks.
Telehealth Services: Physicians who provide telehealth services to Medicare patients should be aware that the Medicare telehealth flexibility has lapsed for care to all patients except those being treated for mental health or substance use disorders. This means that telehealth services are limited to rural areas as they were before the COVID-19 public health emergency and that patients cannot receive telehealth services in their homes. Note, however, physicians in certain Medicare Shared Savings Program accountable care organizations (ACOs) can continue to provide and be paid for telehealth services. In addition, the ability to provide audio-only services to Medicare patients lapsed, as did the Acute Hospital Care at Home program.
Special Diabetes Program & other health extenders: Funding for the Special Diabetes Program and other health extender programs has lapsed. Other programs include the community health centers, the National Health Service Corps, and teaching health centers that operate graduate medical education (GME) programs. It also includes public health emergency authorities (e.g., Public Health Emergency Fund); increased inpatient hospital payment adjustment for certain low-volume hospitals; Medicare-Dependent Hospital (MDH) program; quality measure endorsement, input, and selection; and outreach and assistance for low-income programs (e.g., area agencies on aging).
Medicare Claims: In anticipation of possible Congressional action, CMS has instructed all Medicare Administrative Contractors (MACs) to continue to temporarily hold claims with dates of service of October 1, 2025, and later for services impacted by the expired Medicare legislative payment provisions. This includes all claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and all Federally Qualified Health Center claims. Providers may continue to submit these claims, but payment will not be released until the hold is lifted. For the latest information, physicians should monitor their MAC’s website and this CMS webpage.
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