Hot seats galore! Congressional committees put the pressure on RFK, Jr. and others throughout April
Appearing before dozens of members of Congress in an election year isn’t a walk in the park, especially in this partisan environment where many members are looking for “gotcha moments” to use in campaign ads. HHS Secretary Robert F. Kennedy, Jr. testified before 7 committees over a two week stretch in mid-April, drawing pointed questions and criticism from both sides of the aisle. Some key take-aways on major issues: 1) MFN – The HHS Secretary remains firmly committed to Most Favored Nation (MFN) drug pricing, so much so that he openly invited anti-pharma industry Democrats to work with him on passing MFN legislation (likely because GOP support for the idea remains tepid, at best). Several Republicans pushed back on MFN and government price controls for pharmaceuticals, arguing that such policies weaken U.S. innovation and strengthen the position of countries like China; 2) VACCINES – RFK says he bears no responsibility for the decline in childhood vaccination rates and measles outbreaks that have swept the country over the past year: “It has nothing to do with me.” He pointed to a global rise in measles cases in countries like Canada, Mexico, and the UK, and disputed accusations that he is anti-vaccine, saying he is “pro-science.” Kennedy argued that fewer Americans are vaccinating because they lost trust in government recommendations during the COVID-19 pandemic, and said he was working to restore that trust; 3) NEWBORN SCREENING – When pressed by rare disease champion Rep. Gus Bilirakis (R-FL) about HHS’ newborn screening strategy after dismantling the federal advisory committee last year, Kennedy stammered and said two disease where recently added and the focus is on getting therapies to patients faster (Gridirion’s take: There is no clear HHS strategy to revive the federal role in adding new diseases to the Recommended Uniform Screening Panel (RUSP); 4) HHS/FDA STAFFING – Several Republicans joined Democrats in expressing unease about HHS staffing levels, especially at the FDA. Kennedy defended President Trump’s proposed 12% cut to the HHS budget, but admitted that 2025 workforce reductions had been “painful” and, at times, erroneous. Democrats said the loss of about 3,500 FDA positions have “diminished science” and stalled life-saving drug development. Sen. Thom Tillis (R-NC), who is retiring, said HHS cuts (especially cuts to the National Institutes of Health) were essentially “handing China our lunch” in terms of medical innovation. 5) ABORTION – Several key Republicans demanded that HHS do more to regulate the “abortion pill” mifepristone. In heated exchanges, several Senate Republicans criticized HHS for “slow walking” a comprehensive safety review of the drug. The exchanges revealed that Republicans have their own issues with HHS, Secretary Kennedy and FDA Commissioner Marty Makary. Earlier this year, several anti-abortion groups demanded Makary be fired for his handling of the issue. In all, the HHS Secretary spent more than 15 hours in the hot seat, appearing before major committees in the House and Senate.
Who’s up next in the congressional committee hot seat? On Tuesday, several health system CEO’s appeared before the House Ways & Means Committee. The panel included leaders from HCA Healthcare, CommonSpirit Health, New York-Presbyterian, and ECU (Eastern Carolina) Health. Witnesses were grilled on allegations of inflated hospital pricing, marked consolidation, Medicaid funding cuts and reforms and the state of the nation’s rural health care system. Republicans questioned the CEOs on what they call “extraordinary” hospital price increases and increased consolidation in the market. Democrats were more sympathetic, pointing to rising costs due to reductions in federal funding and increased technology costs. It’s expected that FDA Commissioner Marty Makary will appear before the House Energy & Commerce Committee in May, which Gridiron will be watching very closely!
Trump Administration calls for permanent authorization of the rare pediatric disease Priority Review Voucher program
In what came as a surprise to many observers and advocates, the FDA has asked Congress to make the Rare Pediatric Disease (RPD) PRV program permanent. The proposal, which was included in the FDA’s FY 2027 budget request, would end the familiar four-year reauthorization cycle that has repeatedly put the program at risk of lapsing. For industry, permanent reauthorization could reduce regulatory uncertainty and strengthen incentives for rare pediatric drug development. The RPD PRV program had initially expired at the end of 2024, and Congress struggled over the last year to bring it back. Trump signed the Consolidated Appropriations Act of 2026 on February 3, which included a provision reinstating the program — now funded through September 2029. Patient organizations hailed the permanent reauthorization proposal. The National Organization for Rare Disorders (NORD) said the permanent reauthorization “will speed up innovation and access, ensuring that more patients have a chance at a life not limited by rare disease.” The Muscular Dystrophy Association (MDA) stated: “The RPD PRV is the most important incentive for developing new therapies for ultra-rare neuromuscular diseases. Already, we have seen investors and companies shy away from developing life-changing treatments for our ultra-rare community, and without rapid reauthorization, it will only get worse.” Advocates will need to work with members of Congress to ensure that the language survives the 2027 budget process. Administration officials are defending the President’s April 3 budget proposal before Congress right now, the beginning of committee work on passing a FY2027 budget. Legislative leaders have an ambitious goal of passing the budget by September 30, when the current fiscal year ends. However, as we’ve seen in most recent sessions, a budget agreement is rarely reached before the deadline, prompting continuing resolutions and short-term fixes to avoid a government shutdown. It’s likely that the contentious November mid-term elections will further muddy the waters for a timely, final passage of the FY2027 budget.
Virginia governor recommends changes to Prescription Drug Affordability Board (PDAB) legislation; Legislature says “no”
Virginia Governor Abigail Spanberger (D) received a stunning rebuke from the Democrat-led Virginia General Assembly on April 22. Spanberger had suggested changes to the state’s long-sought Prescription Drug Affordability Board (PDAB) legislation , specifically citing concerns with the authority of the PDAB to set price controls (“upper payment limits”) on drugs and having Medicare’s federally negotiated price caps apply to state-regulated health insurance plans. Spanberger suggested that more research be done on the potential impacts of the legislation and the legislature vote again on the bill next session. The legislature said “no”. The original bill now goes back to the governor for her consideration. The legislature had sent former Governor Glenn Youngkin (R) similar legislation in the past two sessions. He vetoed the bills twice. PDAB legislation is still alive in Illinois, although that bill faces substantial obstacles to pass before the legislature adjourns May 31.
The human face of medical innovation: New BIO “Fight of Our Lives” campaign and former Senator Ben Sasse
It’s always on the top of the list when trying to impact public policy: put a human face to the issues impacting biopharmaceutical and biotech companies. It’s not only about jobs, revenue, manufacturing processes and hard-core science. It’s ultimately about helping people facing enormous health challenges. Bringing hope to fellow human beings at their most vulnerable moments. As America’s biotechnology industry celebrates its 50th anniversary, the Biotechnology Innovation Organization (BIO) launched The Fight of Our Lives awareness campaign in April showcasing the human faces of biotech as the industry continues to lead the world in life-saving innovation. “At a moment of increasing global competition, shifting policy debates, and growing public mistrust of science, the campaign underscores what is at stake for patients and families, and why sustained U.S. leadership in biotechnology matters now more than ever,” BIO said. The campaign spotlights patients facing a variety of challenges—-whose lives have been impacted by medical advances—-but it also spotlights biotech’s progress and its role in the U.S. economy. The Fight of Our Lives landing page is a great resource—check it out! Former Nebraska Senator Ben Sasse has also made the courageous choice to spend time publicly speaking out on his cancer journey and the role of innovative medicine in treating his cancer, which he claims originated in the pancreas. Sasse says the cancer has spread throughout his body. In the midst of discussing his perspectives on life, faith, modern-day politics and family, he also spotlighted the medication that is extending his survival. In a recent 60 Minutes interview, Sasse credited a new “miracle drug” called daraxonrasib, for shrinking his tumor volume by more than three quarters over the last four months. Daraxonrasib, which comes in a once-daily pill form, is manufactured by Revolution Medicines, which reported impressive topline Phase 3 results in mid-April. The company said it plans to submit its data to the FDA through the Commissioner’s National Priority Voucher pilot program this year. The full 60 Minutes interview can be accessed here.
Health Policy Snippets
- Nebraska becomes first state to implement “One Big Beautiful Bill Act” Medicaid work requirements. Nebraskans applying for Medicaid expansion coverage on or after May 1, 2026, will have to prove they meet work requirements or are exempt. Current beneficiaries will be assessed during their next renewal after that date. Last week, the state released this 295-page document detailing what conditions, complete with their billing codes, the state will count as a “medically frail” exemption. Nebraska is the first state out of the gates, implementing work requirements several months in advance of the federal deadline. For those needing a refresh on OBBA Medicaid work requirements, here is a good summary.
- Medicare Medigap premiums skyrocket. Consumer advocates are warning that Medigap (Medicare supplemental policy) premiums—which about 12 million Americans (or 43% of all Medicare fee for service beneficiaries) rely on to cover gaps in the program—continue to rise in 2026 and show no signs of stopping. Some agents report increases of up to 45%, while others say the range they’re seeing is more like 15-25%. “Five years ago, it was exceedingly uncommon to have a carrier with a rate increase of more than 10%. Now it’s very uncommon to see a rate increase below 10%, and it’s not uncommon to see it over 20%,” one agent told CBS News. One potential solution: federal legislation capping out of pocket costs for Medicare beneficiaries who choose a supplemental policy. Critics argue that would drive insurance companies out of the Medigap market.
