Medicare policies face scrutiny over hospital funding and drug access

Hospitals and healthcare providers are expressing significant concern over proposed Medicare policy changes and the practical implementation of drug pricing reforms.

A proposed rule for the outpatient prospective payment system (OPPS) includes provisions that could reduce Medicare reimbursements for 340B-acquired drugs by an estimated $4.55 billion to $4.85 billion next year. Hospital leaders, including executives from Jefferson Hospital in Georgia and Willis Knighton Health in Louisiana, warned that these cuts could force hiring freezes, pay cuts, and layoffs. State hospital associations in West Virginia, Maine, and South Carolina have also projected substantial financial losses due to these proposed reimbursement reductions.

Separately, data regarding the Medicare drug price negotiation program reveals challenges in patient access. Despite the Inflation Reduction Act's mandate for Medicare Part D plans to cover negotiated medications, approximately 24% of patients attempting to fill prescriptions for these drugs faced initial rejections in the first quarter of 2026. Rejection rates were notably higher for oncology (67%) and immunology (59%) medications compared to diabetes and cardiovascular drugs. While the policy aims for government savings, reports suggest that insurers continue to utilize prior authorizations and step therapies, which can prevent patients from accessing prescribed treatments.