By Megan R. Wilson

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In today’s issue: The government has taken on drug pricing, but drugmakers won. … Open enrollment has closed and updated Affordable Care Act enrollment numbers are out. … And, spendy genetic tests drive growth in Medicare Part B expenditures.

Hi there, and welcome to the Health Brief newsletter. The Senate is still divided on how to proceed on the government funding package, which makes a partial shutdown this weekend appear even more likely. Read more on the state of play on Capitol Hill from Riley Beggin and Theodoric Meyer in The Washington Post newsroom.

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This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from the Washington Post newsroom. Learn more about WP Intelligence.

	The Lead Brief

The Trump administration selected 15 more high-cost medications for Medicare drug price negotiation, marking the third round of the Biden-era program — yet high drug costs are likely to continue plaguing consumers.

That dilemma is at the heart of WP Intelligence lead health care analyst Rebecca Adams’s newest sweeping report on drug pricing. You can read that for free here.

She explores how the pharmaceutical industry has been a punching bag for policymakers and leaders in both parties for years, resulting in a series of legislative and regulatory actions targeting the industry in an attempt to rein in drug prices.

→ But one of the key takeaways of her report is that companies have adapted to recent efforts to reduce drug costs, including by introducing new medications at even higher prices.

Launch prices of new medications began increasing exponentially in 2023 — the year after the Inflation Reduction Act, the Democrats’ sweeping law that directs Medicare to negotiate drug prices, was enacted.

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“A lot of that has to do with public policy constraints that have been overly focused on list price growth, but not necessarily controlling for the intrinsic ability to set whatever price you want out of the gate,” Antonio Ciaccia, the CEO of nonprofit group 46brooklyn Research, told Rebecca.

The median annual net price of newly launched drugs increased by 51 percent between 2022 and 2024, according to the Institute for Clinical and Economic Review (ICER), the Boston-based nonprofit that studies the value of prescription drugs. The net price includes the discounts that drugmakers offer to intermediaries called pharmacy benefit managers, or PBMs.

Drug manufacturers argue that the pricing system is complex and say PBMs are to blame for driving up costs because they can sometimes favor higher-priced medications in order to exact larger discounts.

A significant share “of every dollar is going to someone other than the manufacturer making the drug that’s saving your life,” said Alex Schriver, a spokesman for the Pharmaceutical Research and Manufacturers of America, or PhRMA, which represents brand-name drugmakers.

Drugmakers defend the costs for their products by noting that, unlike hospitals, they ultimately face lower prices when patent protections expire and generic drugmakers offer lower-cost competition to the companies that developed the brand-name drugs.

What’s next: A growing number of drugmakers have been asking the Supreme Court to hear their legal challenges to Medicare’s drug price negotiation program, but the high court hasn’t signaled whether it will get involved.

Meanwhile, the White House is pushing Congress to codify the Trump administration’s action to impose most-favored nation (MFN) pricing on medications, aligning U.S. drug prices with other wealthy nations.

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It remains to be seen whether consumers will see benefit from the MFN pricing deals the administration cut with more than a dozen drugmakers, but initial analysis suggests it may be limited. It’s also unclear whether Republican lawmakers are eager to turn the pricing directives into legislative text.

Sen. Bernie Moreno (R-Ohio) is working with a bipartisan group of senators to come up with a compromise to renew the lapsed enhanced Affordable Care Act tax subsidies. (Kevin Dietsch/Getty Images)

	Agency alert

Roughly 23 million Americans have enrolled in Affordable Care Act plans, according to data released by the federal government on Wednesday. About 3.4 million of those people are new enrollees who didn’t have health insurance through the individual marketplace last year.

→ That’s a decrease from the 24.2 million people who enrolled in Obamacare plans in 2025 but an increase from 2024’s enrollment numbers. In 2024, about 21.3 million people purchased health insurance through the marketplaces.

Why it matters: The numbers come following the expiration of enhanced subsidies that helped people on individual plans pay for their insurance. As a result, monthly premiums offered by plans have skyrocketed — more than doubling, on average.

But this isn’t the final count: Experts anticipate that Americans will begin dropping coverage once they cannot afford the payments.

Congress has been at odds on whether to revive the enhanced subsidies. Republicans broadly oppose them, viewing any extension as a stamp of approval on Obamacare. However, there have been bipartisan talks in the Senate to hammer out a compromise.

Politico reported on Wednesday that moderate Republicans would be sending Democrats their “best and final” offer on ways to temporarily restore the enhanced subsidies with some reforms, such as income limits. The comments came from Sen. Bernie Moreno (R-Ohio), one of the lead negotiators in the bipartisan talks.

“It’s going to be in the hands of the Democrats very shortly,” Moreno said, according to the report. “Here’s the exact thing that we think is the maximum we can sell our conference.”

	Numbers Game

$8.4 billion

That’s how much the government spent on diagnostic testing for patients in 2024 as part of the Part B program, which covers doctor’s visits, according to a new report from the Department of Health and Human Services’ Office of Inspector General.

Here are some highlights from the report:

• The $8.4 billion figure is a 5 percent increase over the year before — despite the fact that the overall number of Medicare Part B patients receiving the tests has been decreasing. (That decrease may be attributed to the shift of more people into private Medicare Advantage plans.)
• Most of the spending growth comes from a jump in the amount spent on genetic testing, which seeks to diagnose cancer, fungal infections and epilepsy. Genetic tests tend to be more expensive. Two of Guardant Health’s cancer-related genomic tests cost Medicare roughly $4,900 each, according to payment data listed in the report.
• Genetic testing represented a small amount (5 percent) of the labs people receive through Medicare Part B, but a disproportionate amount — $3.6 billion, or 43 percent — of the spending on diagnostic tests.

	What We’re Reading

“Medicare proposes new transplant system rules that might spur use of less-than-perfect organs,” Lauran Neergaard writes for the Associated Press.

“The psychedelic medicine revolution that wasn’t,” Amanda Chu reports at Politico.

“Kennedy Plan to Test a Vaccine in West African Babies Is Blocked,” report Stephanie Nolen and Christina Jewett at the New York Times.

“Regenxbio gene therapy trials suspended by FDA over safety worries,” Kristin Jensen writes for BioPharma Dive.

“Can Trump and Big Pharma Get the World to Pay More for Drugs?” the Wall Street Journal’s David Wainer writes.