I study the future of the U.S. health system. The framework I use is based on monitoring trends, lag and lead indicators in five zones of unique relevance in the health industry at home and abroad:
- Clinical innovations that produce new diagnostics, therapeutics & methods of care.
- Technologies that improve how processes and decision-making (clinical/administrative) are made, by whom and where.
- Regulations (and politics) that set boundaries, define roles, appropriate public funds, protect public interests and facilitate (or not) competition.
- Capital markets (public and private) that enable funding, define access (credit) and determine costs of capital (monetary & fiscal policies, interest rates).
- Consumers who use and purchase health products and services and vote on health issues.
Based on 30 years-plus years of applying this framework to my industry surveillance process, it’s clear that traditional lag indictors like enrollment, utilization, spending, workforce supply-demand et al are less useful in predicting its future. Instead, indicators from outside healthcare seem more aligned to its future than indicators from within. Why?
- Technologies developed outside healthcare now control the system’s processes and pace of adoption. Technologies are solving problems that legacy healthcare has struggled to address. AI-enabled point solutions are reducing administrative cost and inappropriate clinical variation. Private capital is funding cheaper, and better remedies without permission of insiders.
- The public’s receptive. Public satisfaction with the status quo has plummeted. Expectations have changed. Affordability concerns have been neglected by insiders. Non-healthcare employers are fed-up. And voters are receptive to solutions insiders fear.
- Regulators are changing the rules. Partisan brinksmanship on most contentious healthcare issues has intensified. The Trump administration’s health apparatus (legislative priorities, executive orders, judicial appointments) embraces price transparency, competition, and necessary spending cuts due years of fraud, waste and abuse. And it is facilitating a dramatic increase in state responsibility for implementing and funding its policies.
Objectively, the reality is this: the players outside healthcare including Big Tech, Big Banks and Big Employers are forcing changes faster than healthcare insiders are comfortable and the health system’s future is uncertain as a result. Boards of most healthcare organizations inadequately evaluate future state options due to urgent issues that require attention and/or lack of CEO interest. And in many, long-range planning is relegated to 5-year capital plans and program portfolio updates. Radical change is dismissed, and executive compensation is set accordingly.
Will the health system change radically? Or will it incrementally evolve? To facilitate meaningful discussion, at least three future state possibilities merit deliberation by leaders:
Big Public-Small Private: By 2040, federal and state governments fund 85% of health services funds contracting with private hospitals, medical groups and other providers based on evidence-based performance standards of quality, costs and access. Funding will be sourced from individual and employer taxes while a small percentage of the population will purchase services in a separate, smaller private market. Medicare, Medicaid, CHIP and Social Security programs will be combined (eventually) and budgets will be capped. Note: this model already in place in many developed systems i.e. Canada, UK, et al and is considered an incremental change to the status quo akin to “Medicare for Most” proponents.
Retail health: By 2040, employer tax deductions for employee health benefits are eliminated as a result of employer dissatisfaction with costs and cost shifting by providers based on underpayments by Medicaid and Medicare. Individuals are responsible for purchasing individual insurance and choosing and paying for the doctors, hospitals, medications and ancillary services they use. Note: many economists believe the unintended consequence of third-party health insurance is unnecessary waste, costs and marginalization of consumer choice in healthcare. Forced consumerism, they argue, would bring discipline to health spending. Critics (including most physicians) counter consumers are incapable of smart shopping for their health needs. This option represents a transformational change to the health system wherein its economy is based on retail health.
Restructure: By 2040, system restructuring to reset its focus. The health system’s structure is its major barrier to change. Horizontal consolidation dominant now in most sectors represents a defensive maneuver whereby insiders protect against restructure by imposing its muscle-strength. Current incentives reward specialty providers, inpatient and outpatient services, patent protected specialty drugs, institutional senior care and separate financing and delivery systems. At the same time, they discourage needed investment in behavioral health, enabling of mid-level providers, incentives based on value (costs + outcomes), community-based integration of health and social services programs and guided self-care. Systemic restructure is necessary but unlikely until and unless demanded by community leaders, elected officials and private investors. In the interim, vertically integrated community health organizations will be surrogates for wider adoption.
No one knows for sure what healthcare’s future will be, but all recognize the status quo is not sustainable. Ownership status (for-profit vs. not-for-profit) will matter less and affordability will matter more. Regulation will increase and states will play a larger role. And base rates for reimbursement will decreasingly be based on Medicare rate setting.
Protecting the status quo is not a solution. Failure to seriously evaluate future state options is professional malpractice. Outsiders want results, not excuses.
Paul
PS This week, two of my favorite affinity groups are hosting meetings in Arizona: The Governance Institute and Scottsdale Institute. Each is focused on helping members read the industry tea leaves and each enjoys a reputation for serving its members well. In both, hospitals are the focus: for TGI, its hospital boards, for SI, it’s Chief Information Technology Officers. And for both, preparing members for industry’s future beyond traditional conventional plans that feature facilities, physicians and third-party payments is imperative.
Note: I’ve attended past White House Correspondents Association Dinners in DC. Last night was dramatic: beyond speculation about the shooting incident in weekend coverage, a more important story might be its emotional impact on attendees and even viewers. Having received death threats that required wearing a bullet proof vest (2009-2010), I admit to being rattled. Just sayin’.
Sections in this Report:
- Quotables
- Corporate Health
- Employers
- Federal Rules & Regs
- Hospitals
- Insurers
- Physicians and Nurses
- Population Health
- Prescription Drugs
Quotables
AHA Chair Marc Boom, M.D., president and CEO of Houston Methodist at AHA Annual Meeting in DC last week: “No one is better positioned to advocate for patients than hospitals and health systems, and the clinicians who care for them. We must step into a convening role to address affordability in a meaningful way. This challenge can’t be solved by any single sector acting alone. Instead of pointing fingers, we need to all share accountability and have honest, open collaboration.”
PK Note: Amen! AHA has successfully defended hospitals against encroachment by physician owned hospitals, cuts to the 340B prescription drug program and site neutral payments among its considerable wins for its members. It’s greatest challenge, however, might be playing the convening role Dr. Boom acknowledged in the comment above. None of the major problems facing U.S. healthcare is the fault of a single sector nor solvable without active collaboration by every major player. Having facilitated high level collaborations like this, the outcome will be determined by who participates, the data and deliberation process by which recommendations are developed and discipline among participants in adhering to the process. Most efforts like this fail before they start because one or more parties at the table seeks advantage over others, believing themselves the endowed occupier of the moral high ground above others. It’s necessary to go down this path and hard to do it well. I am hopeful AHA will pursue this effort.
AHA Today April 23, 2026
Rosenthal on husband’s ED experience: “In the last months, weeks, and days of his life, “I will not go to the emergency room” became my husband’s mantra. Andrej had esophageal cancer that had spread throughout his body…
We had already learned the hard way that if you need admission to the hospital, you can remain in the emergency department—in the hallway or a curtained bay on a hard stretcher or in a makeshift holding area—for more than 24 hours, even for days, while waiting for a real hospital bed. In this limbo state, you’re technically admitted to the hospital but still located in the physical domain of the ER. And the rules governing acceptable care and safety measures become much less clear…
Measuring the problem has been challenging because data on ED-boarding time are limited. Only this past November did the Centers for Medicare and Medicaid Services finalize a rule that would require hospitals to collect data on ED-boarding times, starting in 2026. Using what other data he could find, Haimovich has shown that boarding for more than 24 hours has increased dramatically for people 65 and older since the coronavirus pandemic.
Once they enter ED boarding, patients exist in a gray zone. There has been a national push to establish “safe staffing” nurse-to-patient ratios in EDs.
A ‘Barbaric’ Problem in American Hospitals Is Only Getting Bigger – The Atlantic
Corporate Health
Arguably, HCA Healthcare and UnitedHealth Group are healthcare’s most prominent players. Both are their sector’s biggest player and both attract media attention routinely. Last week, each reported latest earnings:
“HCA Healthcare, Inc. (NYSE: HCA) today announced financial and operating results for the first quarter ended March 31, 2026. Key first quarter metrics (all percentage changes compare 1Q 2026 to 1Q 2025 unless otherwise noted):
- Revenues increased 4.3% to $19.109 billion
- Net income attributable to HCA Healthcare, Inc. increased 0.6% to $1.620 billion
- Diluted earnings per share and diluted earnings per share, as adjusted, increased 10.9 % to $7.15 per diluted share
- Adjusted EBITDA increased 1.9% to $3.802 billion
- Cash flows from operating activities increased 22.0 percent to $2.014 billion
- Same facility admissions increased 0.9% and same facility equivalent admissions increased 1.3%
As of March 31, 2026, HCA operated 189 hospitals and approximately 2,600 ambulatory sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics, in 19 states and the United Kingdom.”
HCA Healthcare – Investor Relations
UnitedHealth Group Reports First Quarter 2026 Results
- First Quarter 2026 Revenues of $111.7 Billion Grew 2% Year-over-Year
- Earnings of $6.90 Per Share and Adjusted Earnings of $7.23 Per Share
- Full Year 2026 Earnings Outlook Raised to Greater Than $17.35 Per Share; Adjusted Earnings of Greater Than $18.25 Per Share
UnitedHealth Group (NYSE: UNH) today reported first quarter 2026 results, with performance supported by actions taken over the last several quarters.
“We are continuing to help simplify and modernize health care for the people and care providers we serve, bringing greater value, affordability, transparency and connectivity,” said Stephen Hemsley, chief executive officer of UnitedHealth Group.
The company expects full year 2026 adjusted net earnings of greater than $18.25 per share.
Consolidated revenues for the first quarter 2026 were $111.7 billion, with earnings from operations of $9.0 billion. Net margin was 5.6% compared to 5.7% in the year ago quarter. Cash flows from operations were $8.9 billion, or 1.4x net income, and the debt-to-capital ratio was 42.9% as of March 31, 2026.
UnitedHealthcare served 49.1 million consumers and expanded operating margins by 40 basis points to 6.6% compared to 6.2% in the first quarter 2025. Optum supported more than 122 million consumers across its businesses, driving revenues of $63.7 billion and earnings of $3.3 billion, reflecting a margin of 5.2%. Optum Health operating earnings were $1.1 billion. Adjusted operating earnings were $1.3 billion, excluding the impacts related to the third-party loss contracts and restructuring actions disclosed in the fourth quarter 2025.
UnitedHealth Group Reports First Quarter 2026 Results – UnitedHealth Group
Employers
Purchaser Business Group on Health’ Mitchel on employer costs: “The affordability crisis is hitting employers hard and their strategies, as assertive as they are, are not really addressing the costs adequately,” said Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health, which estimates its 40 large employer members spend $350 billion a year to cover 21 million people.
Like the Small Business Majority, the Purchaser Business Group on Health has been sending members to the Hill to explain exactly what businesses are facing in healthcare. So has the National Alliance of Healthcare Purchaser Coalitions. The coalition of mid- to large-sized companies held a healthcare summit and a lobbying day of its own this month and participated in the Small Business Majority event along with the liberal healthcare advocacy group Families USA.”
Hospital price transparency gains steam as employers seek savings – Modern Healthcare
Peterson-KFF Tracker on employer benefits: “The analysis blends results from surveys from the Bureau of Labor Statistics and KFF Employer Health Benefits Survey, with insights from interviews and group discussions held with employers throughout the summer and fall of 2025 across the United States covering over 100 companies employing over a quarter of a million people.” Key takeaways:
- Health insurance compensation makes up an average of 8% of total compensation for all employees, but the dollar amounts vary by type of occupation.
- On average, around 3 in 4 employees are offered health insurance, and about 65% of those offered enroll in the benefit, but again, this varies by occupation.
- Service workers, which constitute a large proportion of lower-waged workers, are offered less in health insurance compensation and are less likely to be offered the benefit (52%). When offered, they are less likely than average to enroll.
- For employers who offer health insurance coverage options, they may offer low-premium plan options, tiered health insurance payments for lower-waged workers, or in-network options with no or low copays for care to support lower-waged workers.
- Large firms (over 5,000 employees) are most likely to offer health insurance premium supports for their lower-waged workers (29%), such as offering lower premiums to factory workers compared to “professional” workers.
Federal Rules and Regs
CMS to require states to verify clinician credentials: Last Tuesday, CMS announced plans to require states verify medical providers paid by federally funded health care programs as part of a broad effort to combat fraud in government programs.
“The announcement is another step from the administration in its aggressive — and highly publicized — attacks on alleged waste, fraud, and abuse in federal health care programs. The administration has targeted certain programs and providers primarily in Democrat-led states such as Minnesota and California, though the administration’s claims have been disputed at times by state leaders.
States that don’t take the effort seriously, he said, could become targets of closer federal scrutiny.
Feds to require states to audit health care providers | STAT
Foley and Lardner on government fraud, waste and abuse emphasis: “Congress and the Trump Administration have issued a series of heightened warnings indicating an emerging effort to crack down on what it terms rampant “fraud, waste, and abuse” in the health care industry. All industry stakeholders should be aware of this new focus, which not only signals potentially heightened scrutiny and enhanced penalties for compliance issues but also potential policy changes intended to reduce federal expenditures on programs or practices that are identified as improper or wasteful.
Efforts to date include the creation of an interagency Task Force to coordinate and strengthen fraud prevention and enforcement activities across affected programs, an increased focus on criminal prosecutions, and a six‑month nationwide moratorium on Medicare enrollment for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers, which the Centers for Medicare & Medicaid Services (CMS) states is necessary due to longstanding fraud, waste, and abuse in the DMEPOS sector.
A key aspect of the federal initiatives are attempts to compel states and other non-federal actors to adopt a similar focus. Most significantly, CMS temporarily deferred approximately $259.5 million in federal Medicaid matching funds to Minnesota based on allegations that the state had failed to take adequate steps to ensure program integrity. CMS has warned that if Minnesota fails to remediate identified program integrity vulnerabilities, the agency may defer more than $1 billion in federal funds over the next year.
Emerging Effort to Crack Down on Fraud, Waste, and Abuse
CMS replaces REACH with LEAD: “In December, CMS announced a new Medicare accountable care organization (ACO) model called LEAD. The LEAD model replaces the ACO REACH model, which was originally introduced in 2022 and will end in December 2026. LEAD, which will begin Jan. 1, 2027, is a voluntary, 10‑year model designed to support long‑term participation in total cost‑of‑care accountability while also improving financial sustainability for organizations serving complex and high‑needs Medicare populations.
Like ACO REACH, LEAD is a two‑sided risk model offering prospective, population‑based payments and accountability for quality and cost outcomes in traditional Medicare. However, LEAD places a stronger emphasis on predictability, scalability, and durability, with design features intended to reduce churn, stabilize benchmarks over time, and better support rural providers and organizations caring for high‑needs and dual-eligible beneficiaries.
Interested ACOs have until May 17 to apply.”
LEAD: Can CMS’ new model expand value-based care? | VBCExhibitHall Library
Axios on FDA plan to limit prescription drug ads: “… the Trump administration and lawmakers from both parties seek new controls on ads that account for more than $10 billion in annual spending. The U.S. and New Zealand are the only countries that allow direct-to-consumer pharmaceutical advertising, which critics blame for promoting unnecessary drug use and driving up health costs. But any policy shifts will likely face strong industry resistance and could collide with free speech concerns.
The FDA, in its 2027 budget request this month, asked Congress to give it new authority to crack down on drug ads that lack “fair balance” on the benefits and risks of taking a product. The agency wants to address messages that are “frequently misleading and confusing to consumers and patients,” per the budget document.
The FDA cites a 2024 review in the Journal of Pharmaceutical Health Services Research that found only 33% of drug industry social media posts mention potential harms.”
Hospitals
Paragon Institute on hospital prices, costs: “This paper argues that U.S. hospitals, which account for roughly one-third of health spending, operate in a government-shaped system that rewards consolidation, opacity, and inefficiency rather than competition, value, and accountability. It contends that policies such as certificate-of-need laws, payment differentials between care settings, restrictions on physician-owned hospitals, Medicaid financing gimmicks, and broad subsidies have driven hospital prices far above inflation, encouraged hospitals to acquire physician practices and merge into large health systems, and weakened consumer pressure on costs. Despite claims of financial strain, the paper says many hospitals maintain solid margins, investment income, and reserves while spending heavily on administration and other non-patient-care costs. The result is a costly, distorted market that burdens patients, employers, and taxpayers with high and unpredictable prices. To restore competition and improve efficiency, the paper recommends reforms such as site-neutral payment, stronger price transparency and subsidy oversight, repeal of anticompetitive rules, targeted charity-care standards, and restructuring hospital support programs to reward quality, efficiency, and genuine need.”
John_R_Graham_The-Hospital-Cost-Crisis_RELEASE_V4.pdf
Related: AHA response to Paragon report: “The latest report from Paragon, which has targeted hospitals, relies on a long list of distorted and debunked arguments. Further, many of their recommendations would lead to reduced or closed hospital services, decreased access to care, and poorer health outcomes for patients and communities. The following are just four ways that the report draws faulty policy conclusions from abstractions divorced from the realities of care delivery.
- Paragon Misdiagnoses the Cost Problem and Prescribes the Wrong Fix. Paragon treats hospital cost growth as a pricing problem disconnected from the reality hospitals operate in. In practice, hospital spending pressures are driven by input costs and care intensity.
- Government Payments Are Not “Subsidies: The report’s emphasis on Medicare “marginal profit” is particularly misleading. That metric deliberately strips out fixed costs (buildings, standby staffing, trauma capacity, and 24/7 readiness — all absolutely fundamental to providing care) and asks only whether payment exceeds the variable cost of one additional patient.
- The Report’s Cross‑Sector Comparisons Are Deeply Misleading. Airlines and hotels provide no better analogy. They can cancel routes, shrink capacity, raise prices based on demand, and turn away unprofitable customers. Hospitals cannot. They are committed to treating all patients regardless of ability to pay, maintaining standby capacity at all hours and continually innovating to provide cutting-edge treatment.
- The Report Gets Rural Health Care Wrong and Communities Pay the Price. Rural hospitals operate in a distinct and difficult environment — low patient volumes, high fixed costs, workforce shortages, challenging payer mix, and little leverage with commercial insurers. These challenges cannot be solved through “efficiency” alone.
It is clear from this report that Paragon isn’t focusing on the real issues facing hospitals, health systems and clinicians on the front lines of providing care each day, especially when they can curate their arguments to respond to strawman positions that don’t reflect the reality that hospitals and communities face. We will continue to set the record straight.”
Why Paragon Gets Hospitals Wrong: Report Ignores Reality of Care Delivery https://www.aha.org/news/blog/2026-04-23-why-paragon-gets-hospitals-wrong-report-ignores-reality-care-delivery
PK Note: Paragon and AHA rely on metrics that support their views and each omits key data to make their points. An objective, independent, data-driven assessment of hospital finances past, present and future is needed in which clinical innovations, workforce and technology modernization and population health changes are integrated.
Health Affairs on 340B program: “Since its creation in 1992, however, the US health care system has changed dramatically, and the 340B program has expanded far beyond its original scope. Today, it is the second-largest federal drug pricing program in the United States. In 2024, the total value of drugs purchased through 340B reached nearly $150 billion at undiscounted prices, a 21% increase from the prior year. More than half of US hospitals now participate, and hospitals account for 87 percent of all program sales.
Yet, the program was designed for a world in which Medicare Part D did not exist, Medicaid covered far fewer people, and subsidized private coverage was unavailable to most low-income Americans. Today, Medicaid, Medicare Part D (including the Low-Income Subsidy), and Affordable Care Act (ACA) coverage already pay for prescription drugs for the vast majority of patients whom 340B was meant to help…
The Government Accountability Office estimates that more than 2,600 hospitals participated in 340B in 2023—more than half of all US hospitals. As eligibility expanded and patient definitions broadened, the volume of discounted drug purchases surged. Between 2018 and 2024, 340B sales at undiscounted prices nearly tripled.”
The 340B Drug Pricing Program Is a Hidden Tax Expenditure | Health Affairs
Study: Association between heat index and ED use: “We used 2016–23 health insurance claims from a large, national insurer and national temperature and humidity data to conduct a regression analysis on the relationship between extreme heat exposure and ED, inpatient, and outpatient use and cost in the commercial insurance, Medicaid, and Medicare Advantage (MA) populations. One additional day with a heat index of 100°F or hotter within a week was associated with increased ED use and cost across nearly all coverage populations and age groups. Extreme heat was associated with significant increases in inpatient use for children with commercial coverage (1.4 percent), members ages 18–64 with Medicaid coverage (0.47 percent), and MA members (0.5 percent) but was not associated with statistically significant increases in inpatient cost for any population group. It was not associated with increases in outpatient use or cost in any population group. MA members had the highest annual cost due to extreme heat. These findings provide evidence to inform population health management strategies, seasonal preparedness planning, and policy interventions to mitigate heat-related morbidity and health care costs.
Physicians and Nurses
NSI Study: Cost of Nurse Turnover in Hospitals: “Last year, the hospital workforce increased by 176,500 employees, a 3.04% add rate. Of this, 53,500 RNs were hired which represents a 2.9% RN add rate. While the hospital workforce continued to grow, hiring momentum did slow by 2.4% from the prior year. Turnover continues to remain elevated. Nationally, the hospital turnover rate is 18.5%, a nominal increase from CY24, and RN turnover is recorded at 17.6%, a 1.2% increase…. According to the survey, the average cost of turnover for a bedside RN is $60,090 resulting in the average hospital losing between $4.2m – $6.2m. Each percent change in RN turnover will cost/save the average hospital an additional $295,000/yr. The 1.2% increase in RN turnover negatively impacted the bottom line by $360k. Nationally, the RN vacancy rate stands at 8.6% with a third (33.1%) of the hospitals reporting a vacancy rate of ten percent or higher. The RN Recruitment Difficulty Index decreased to 78 days. In essence, it takes over 2.5 months to recruit an experienced RN. The RN labor shortage is not going away any time soon. Based on survey responses, NSI estimates the current national RN shortage at 158,600. After increasing pay scales and inflating sign-on bonuses, hospitals still have an average of 43 unfilled RN FTEs. “
nsi_national_health_care_retention_report.pdf March 2026
FDA approves breakthrough device approval acceleration policy: Last Thursday, the FDA announced a new Medicare coverage pathway for devices deemed breakthroughs. The new Regulatory Alignment for Predictable and Immediate Device coverage pathway (RAPID), will try to synchronize the FDA’s premarket review process, which determines whether products are safe and effective, and Medicare’s independent process which determines whether paying for devices is reasonable and necessary. The goal is to collect and review enough data before authorization that Medicare can cover the products soon after a product hits the market.
CMS, FDA propose new, faster coverage for breakthrough devices
Polling
Harvard polling of young adults: Per the Spring 2026 Harvard Youth Poll of 2,018 young adults between 18 and 29 years old conducted March 26 and April 3, 2026:
- Economic pressure defines this moment for young Americans: Inflation (50% impacted “a lot”) and housing (41%) drive both lived experience and urgency, alongside widespread financial strain and a sharp decline in long-term optimism.
- Military action in Iran is seen as not in the best interests of Americans: A majority say military action is not in the U.S. interest, with 72% worried about escalation and 71% about economic impact.
- The country feels off track:Only 13% say the U.S. is headed in the right direction, while 59% say it’s on the wrong track, and approval remains low for President Trump (25%) and both parties in Congress (26% Democrats, 25% Republicans).
- Young voters favor Democrats:Democrats lead 45% to 26% among young registered voters in the generic ballot. While Democrats say they are more likely than Republicans to vote in November (Democrats 55%, Republicans 35%, Independents 25%), a plurality remain cynical about the system as a whole.
- Trust in the system is weak:Just 33% of young Americans say they trust the 2026 elections will be conducted fairly, while 43% do not and 21% are unsure, highlighting deep uncertainty about the integrity of the process.
52nd Edition – Spring 2026 | The Institute of Politics at Harvard University
Population Health
Study: Hep C utero testing: A study of more than 4,500 US infants exposed to hepatitis C virus (HCV) in utero or at birth from 2014 to 2021 finds that only 42% were later tested for the potentially serious but highly treatable infection, and few received the recommended treatment. A team led by Boston University researchers used a statewide health database to explore factors tied to HCV testing of perinatally exposed infants in Massachusetts and estimated the proportion of infants diagnosed as having perinatal HCV infection who then receive care.
Hepatitis C Virus Testing in Perinatally Exposed Children JAMA Netw Open April 17, 2026 2026;9;(4):e260743. doi:10.1001/jamanetworkopen.2026.0743
STAT on psychedelics approvals: “Over the weekend, President Trump signed an executive order to increase the availability of certain psychedelics as treatments for mental health conditions, ordering that $50 million be spent, and that the Food and Drug Administration fast-track reviews to usher in their approval. At one point, the president joked to the motley assembly of administration officials, a former Navy SEAL, and the podcaster Joe Rogan: “Can I have some, please?”
On Wednesday, the Trump administration announced it had downgraded medical marijuana from the highest tier of controlled substances, and was pushing the Drug Enforcement Administration to do the same for recreational marijuana.
The president’s lenient tack on some mind-altering drugs ushers in a new world of right-wing drug policy. While the administration has emphasized hardline, militaristic tactics when it comes to fentanyl, its recent actions on “softer” drugs could represent a new era not just for Republican politics but also for American drug policy writ large.”
GOP drug policy shifting as Trump boosts psychedelics, marijuana | STAT
(Related) WSJ on Trump approval of psychedelics: “On Saturday, in a rare weekend signing ceremony, President Trump authorized a fast-track review of psychedelic drugs, including LSD and ibogaine. Trump was encouraged to take the step by Joe Rogan, the world-famous podcaster, who has one of the biggest media platforms on the planet.
Then, on Thursday, the White House reclassified marijuana as a less-dangerous drug, which could make it much easier to buy and sell pot. This could also serve as a boon for the multibillion-dollar cannabis industry, and some of the industry’s leaders have been pushing Trump to make the move…
Republicans in recent months have seen their coalition start to crack over concerns about health policy, foreign policy, and immigration policy (that, right there, accounts for a lot of the White House policy). Trump is surrounded by advisers who clue him into when his supporters are starting to squirm, and he does know how to reel them back in. Will these changes help? We’ll see.”
NYT Editorial on family planning: “Decreasing the unintended pregnancy rate was a bipartisan wish. In 1969, President Richard Nixon recognized that “unwanted or untimely childbearing is one of several forces which are driving many families into poverty.” A year later, Congress passed Title X: the first federal program entirely dedicated to family planning and reproductive health care.
It would go on to become one of the most successful federal programs of the last century, with one study finding it prevented some 20 million unintended pregnancies in just 20 of its 50 years by providing women with free and low-cost birth control. It has significantly reduced child poverty. In 1957, nearly one in 10 teenage girls gave birth. Today, the rate is closer to one in 100. For every dollar spent on family planning funds, the government saves $7 in Medicaid costs.”
Prescription drugs
Pancreatic cancer drug shows promise: “Pancreatic cancer killed nearly 52,000 Americans last year, many within a year of diagnosis. Now, there are some new experimental medicines with the potential to change that.
New data from two drugs showed it might be possible to keep the disease in check for longer than ever before. One drug, developed by Revolution Medicines, shrank tumors in roughly half of people who used it as a first treatment. And an mRNA vaccine made by Germany-based BioNTech and Genentech kept most patients who responded to it alive six years—an unusually long stretch for a cancer that normally leaves only around one in eight people alive five years after diagnosis.”
New Drugs for Pancreatic Cancer Show Remarkable Promise for Deadly Disease – WSJ
AMCP Report: Specialty Drug Market: “For decades, patent expiration primarily impacted traditional primary-care drugs. However, following the first major generic wave triggered by Prozac’s patent loss in 2001, the industry pivoted toward specialty and rare disease therapies. Now, specialty drugs are beginning to lose exclusivity, with substantial savings opportunities in a highly concentrated number of products…. over the next 5 years, roughly $137 billion in brand sales are at risk, with about half attributable to specialty medications. In 2026 alone, more than $43 billion in brand sales face generic competition, with more than half of that value in diabetes and other traditional drugs and the rest coming from first-time generic specialty drugs…
Regarding biosimilars, Caffiero noted that the FDA has now approved 83, accelerating sharply to 18 per year in 2024 and 2025. A total of 65 have been launched to date, targeting 17 reference biologics. She highlighted that a cluster of major biologics will generate the next wave, with nearly $80 billion in potential savings through 2030…
Over the next decade, approximately 118 biologics are expected to lose exclusivity. However, she noted there is currently a “biosimilar void” as a modest number of biosimilars are in development, leaving more than $230 billion in potential spending at risk if competition fails to materialize.
With 92 cancer drugs approved overall and 16 novel agents approved in 2025 alone, the field has shifted away from treating cancer broadly toward more biomarker-driven, narrowly defined patient populations…”
Comments by Nicole A. Caffiero, PharmD, MBA, BCACP, at the Academy of Managed Care Pharmacy (AMCP) 2026 meeting last week in Nashville, Tennessee.
AMCP 2026 Spotlights New Era for Specialty Drug Market | AJMC
STAT on PBM regulation pushback: “The Trump administration’s desire to pry open the black box of prescription drug prices is facing stiff opposition from the phalanx of lobbyists representing pharmacy benefit managers and health insurers.
In January, the Department of Labor proposed a rule that would mandate PBMs disclose a wide range of drug pricing information to employers and make it easier to be audited. The public had until last week to submit comments.
A review of the more than 500 letters that poured in reflects a mélange of drug pricing interests: predictable resistance from PBMs and health insurers, which generate billions of dollars in profit every year from their role as gatekeepers of drug spending; enthusiasm from Mark Cuban’s pharmacy and others in the business community who want middlemen to face more accountability; and a semblance from the pharmaceutical industry of having one’s cake and eating it, too: Drug companies cheered PBMs being in the regulatory crosshairs but wanted pullback on disclosure of drug pricing data. “
