Healthcare

The VA National Formulary Act of 2025 creates a single, uniform list of drugs available at all VA medical facilities, replacing any local drug lists. It establishes a Pharmacy and Therapeutics Committee to make evidence-based decisions on drug inclusion (reviewing new FDA-approved drugs within 120 days) and sets up a 96-hour timeline for processing veterans' requests for nonformulary drugs. The VA must report annual formulary changes to Congress and implement a tiered copayment system that lowers costs for formulary drugs. The bill also includes provisions for negotiating drug discounts and value-based agreements to achieve cost savings.

HR 1909 reauthorizes federal funding and updates programs to reduce maternal deaths. It requires maternal mortality review committees to include obstetricians/gynecologists and improves death certificate reporting by coordinating with death certifiers. The bill mandates the CDC to share annual best practices for preventing maternal mortality with hospitals, state health groups, and perinatal programs. It also increases annual funding from $58 million to $100 million for these initiatives, covering fiscal years 2025 through 2029. The law directly affects hospitals, state health agencies, and maternal health programs receiving these federal funds.

Veterans' Assuring Critical Care Expansions to Support Servicemembers (ACCESS) Act of 2025 This bill addresses the administration of the Veterans Community Care Program (VCCP) and other Department of Veterans Affairs (VA) health care matters. Among other provisions regarding the VCCP, the bill establishes in statute access standards that determine when a veteran is eligible to receive non-VA care through the VCCP, requires the VA to notify veterans regarding their eligibility for care within two business days after the VA is aware the veteran is seeking care, and extends the deadline for the submittal of claims under the VCCP by health care entities and providers. The VA must address its mental health treatment programs by establishing a standardized screening process to determine whether a veteran satisfies criteria for priority or routine admission to a mental health residential rehabilitation treatment program or a program for residential care for mental health and substance abuse disorders, tracking the performance of medical facilities and Veterans Integrated Service Networks in meeting the requirements for mental health treatment screenings and timely admission to treatment programs under such screenings, and establishing an appeal process for when a veteran is denied admission to a covered treatment program or is accepted into a program but not offered bed placement in a timely manner. Additionally, the VA must establish an online self-service module for veterans to request and manage appointments, track referrals, and appeal and track decisions related to requests for care.

The HANDS Act (HR 5120) requires Medicare, Medicaid, and TRICARE to cover opioid overdose reversal drugs (such as naloxone) at no cost for patients at risk of opioid overdose who are being discharged from hospitals, emergency departments, or ambulatory surgical centers. Starting January 1, 2026, these drugs must be provided at the time of discharge along with administration instructions, eliminating all cost-sharing (like deductibles or copays) for eligible patients. The bill defines "preventive opioid overdose reversal drugs" as intranasal or intramuscular medications administered by healthcare providers (e.g., doctors or nurses) to at-risk patients during discharge. This policy aims to increase access to life-saving medication at critical care transition points without mandating provider administration.

This bill requires online contact lens sellers to provide a secure electronic method for customers to transmit their contact lens prescriptions, directly affecting online retailers. It mandates that such electronic transmissions comply with HIPAA privacy rules and that any protected health information sent via email must be encrypted. The law updates existing rules to modernize prescription verification for online sales while maintaining privacy protections.

Dentist and Optometric Care Access Act of 2025 or the DOC Access Act of 20 25 This bill prohibits private health insurance plans from setting rates for items and services, except for dental cleanings, provided by a doctor of optometry, of dental surgery, or of dental medicine (or an employer of such a doctor) for which the plan does not pay a substantial amount. Additionally, an agreement between a plan and such a doctor for limited scope dental or vision benefits may last longer than two years only with the prior acceptance of the doctor for each term extension. Plans also may not restrict such a doctor's choice of laboratories or suppliers. Such doctors may elect to waive the application of the payment amount and choice of laboratories provisions of this bill. The bill does not supersede state laws regarding health insurers and dental or vision benefit plans.

HR 6444 establishes a VA-DoD task force to improve care for veterans and active-duty service members diagnosed with blast-related injuries like traumatic brain injury (TBI) or PTSD. The task force will coordinate research on specific issues (e.g., sleep therapy, gut health, brain inflammation), develop clinical baselines, and create guidelines for evaluating disability claims related to blast exposure. It must report annually to Congress on research progress and claim evaluation recommendations, and will expire on September 30, 2029. The bill directly affects veterans and service members with blast exposure symptoms by focusing research and care coordination on their specific health needs.

The Kidney Care Access Protection Act (HR 6214) improves access to innovative kidney treatments for Medicare beneficiaries with end-stage renal disease. It extends transitional payment adjustments for new renal dialysis drugs and devices for at least three years, then establishes permanent payment adjustments based on actual utilization and costs. The bill also expands Medicare's annual wellness benefit to include kidney disease screening and increases access to kidney disease education services through renal dialysis facilities. These changes apply to Medicare beneficiaries, renal dialysis facilities, and healthcare providers, with key provisions effective January 1, 2026.

The ROOT Act requires doctors ordering certain outpatient imaging tests (like X-rays or MRIs) under Medicare to consult a qualified clinical decision support tool before prescribing, starting January 1, 2026. It exempts preventive screenings (such as mammograms, lung cancer CT scans, and colonoscopies) and orders from small/rural practices. Doctors must report this consultation to Medicare, and the government will track "low compliant" providers who fail to use the tool, with potential future actions like payment adjustments. This primarily affects physicians ordering imaging services in outpatient settings covered by Medicare.

This bill requires the Department of Veterans Affairs (VA) to conduct a comprehensive assessment within 72 hours for veterans identified as needing homeless program services who have mental health needs. The assessment must cover physical/mental health needs, create a care plan addressing immediate and long-term support, and identify suitable housing. VA staff must integrate this information into veterans' electronic health records while following privacy laws. The VA Homeless Program Office must also monitor whether these care plans effectively address veterans' needs. This directly affects homeless veterans with mental health challenges who access VA homeless services.