In brief: PBM reform bill, dual-eligible data book, OSA-insomnia link

WASHINGTON – U.S. Senate Finance Committee Chairman Mike Crapo, R-Idaho, and Ranking Member Ron Wyden, D-Ore., have introduced the Pharmacy Benefit Manager (PBM) Price Transparency and Accountability Act to fix market distortions and increase transparency in federal prescription drug programs to lower patient costs at the pharmacy counter. 

“Pharmacy benefit managers should not profit from overcharging patients for their prescriptions,” said Crapo. “This bipartisan legislation is a decisive step toward making the prescription drug market easier to navigate for both patients and pharmacies. These proposals form a strong foundation for additional efforts to promote pharmacy access, demystify drug pricing and reduce costs for both taxpayers and seniors.” 

The PBM Price Transparency and Accountability Act would: 

• Delink PBM compensation from their negotiated rebates to disincentivize PBMs from promoting higher-priced medications; 
• Increase PBM reporting requirements to Medicare Part D plan sponsors and to the U.S. Department of Health and Human Services (HHS) and empower Part D plan sponsors to audit their PBM for compliance with contract requirements; 
• Reinforce existing requirements that plan sponsors contract with any willing pharmacy that meets their standard contract terms and conditions to better protect independent pharmacies in rural areas from practices that have contributed to widespread closures; 
• Require participation by retail community pharmacies in the National Average Drug Acquisition Cost (NADAC) survey, which would ensure accurate Medicaid payments to pharmacies; and 
• Mandate PBMs pass Medicaid payments directly to pharmacies to ensure transparent drug costs for states and taxpayers. 

The National Community Pharmacists Association (NCPA) is urging Congress to pass the bill. 

“We would like to thank Chairman Crapo and Ranking Member Wyden for their hard work and steady support for these reforms,” said NCPA CEO B. Douglas Hoey. “The president and Congress have expressed a strong interest in bringing down drug costs and these reforms are the most comprehensive and substantive way to make progress toward achieving that goal. NCPA urges Congress and the president to pass this legislation and sign it into law. The PBMs and insurance conglomerates are driving up drug costs, crushing small-business pharmacies, and creating pharmacy deserts. There is wide bipartisan support for these reforms, so there are no excuses for letting another year slip by without passing them.”  

The bill contains the same key reforms that nearly passed last December but were stripped out at the last minute when spending negotiations broke down, says NCPA. 

The following senators co-sponsored the bill: 

• John Barrasso, R-Wyo. 
• Michael Bennet, D-Colo. 
• Marsha Blackburn, R-Tenn. 
• Catherine Cortez Masto, D-Nev. 
• Bill Cassidy, R-La. 
• Maggie Hassan, D-N.H. 
• John Cornyn, R-Texas 
• Ben Ray Luján, D-N.M. 
• Steve Daines, R-Mont. 
• Tina Smith,D-Minn. 
• Chuck Grassley, R-Iowa 
• Mark Warner, D-Va. 
• James Lankford, R-Okla. 
• Raphael Warnock, D-Ga. 
• Roger Marshall, R-Kan. 
• Peter Welch, D-Vt. 
• John Thune, R-S.D. 
• Sheldon Whitehouse, D-R.I. 
• Thom Tillis, R-N.C. 

The legislative text can be found here. 

MedPAC, MACPAC publish data book on dual eligibles 

Among their findings: Dual eligibles for Medicare & Medicaid account for a disproportionate share of spending in both programs 

WASHINGTON – The Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC) have released a newly updated data book: Beneficiaries Dually Eligible for Medicare and Medicaid.  

This edition describes the dually eligible population’s composition, service use and spending in calendar year 2022, and includes new data on Medicaid service use and spending for dually eligible beneficiaries in comprehensive Medicaid managed care. 

Key statistics in this year’s data book include: 

• There were 13.6 million people who were dually eligible for Medicare and Medicaid for at least one month in 2022. 
• People who are dually eligible for Medicare and Medicaid account for a disproportionate share of spending in both programs. Dually eligible beneficiaries totaled 20% of the Medicare population in 2022 but accounted for 36% of Medicare spending. Similarly, dually eligible beneficiaries accounted for 13% of all Medicaid beneficiaries but 27% of Medicaid spending. 
• Reflecting the continued shift from fee-for-service (FFS) to managed care in Medicare and Medicaid, in 2022 a majority of dually eligible beneficiaries (51%) were enrolled only in managed care for their Medicare benefits, 38% were enrolled only in Medicare FFS, and 11% spent part of the year in FFS and part of the year in managed care. For Medicaid services, 43% of dually eligible beneficiaries had at least one month of comprehensive managed care enrollment. 
• Looking specifically at comprehensive Medicaid managed care, dually eligible beneficiaries under age 65 had lower use of institutional long-term services and supports than individuals age 65 or older (4% vs. 11%) and lower expenditures (13 percent versus 36 percent). 
• Roughly one-quarter (27%) of all dually eligible beneficiaries had at least one month in which they were simultaneously enrolled in a Medicare managed care plan and a comprehensive Medicaid managed care plan. Another 49% of all dually eligible beneficiaries had some enrollment in Medicare managed care and/or comprehensive Medicaid managed care but not simultaneously.  

The data book is available on websites of both agencies: www.macpac.gov and www.medpac.gov.  

OSA, insomnia linked to poor memory in women 

DARIEN, Ill. – New research among older adults with sleep apnea reveals that verbal memory performance is significantly worse in women – but not in men – who also have insomnia. 

According to a new study published in the Journal of Clinical Sleep Medicine, the official publication of the American Academy of Sleep Medicine (AASM), older adults with comorbid insomnia and sleep apnea – often referred to as COMISA – demonstrated worse memory performance than those with sleep apnea alone. This interaction remained significant even after adjusting for age, body mass index, sleep apnea severity, and education. However, when analyzed by sex, COMISA was significantly associated with worse verbal memory outcomes in women, but not in men.  

“We expected that having both insomnia and sleep apnea would worsen memory for everyone, but only older women showed this vulnerability,” said lead author Breanna Holloway, who has a doctorate in clinical psychology and behavioral medicine and is a postdoctoral researcher at UC San Diego School of Medicine. “That was striking, especially because women typically outperform men on verbal memory tasks. The fact that COMISA seemed to offset that advantage hints at a hidden sleep-related pathway to cognitive decline in women. Prior studies have shown increased incidence of Alzheimer's disease in women with untreated sleep apnea.” 

The study involved 110 older adults between the ages of 65 and 83 who were diagnosed with OSA. They completed an overnight sleep study and cognitive testing, and insomnia and verbal memory were assessed using validated tools. COMISA was present in 37% of participants.  

According to the authors, sex differences in sleep architecture may explain the cognitive vulnerability observed in women with COMISA. Post-hoc analyses revealed that women with COMISA had reduced rapid eye movement sleep and more slow wave sleep compared with men, underscoring the importance of considering sex-specific patterns when evaluating COMISA. 

“These results point to an overlooked risk in women with both insomnia and sleep apnea,” said Holloway. “Because women are more likely to have insomnia and often go undiagnosed for sleep apnea, recognizing and treating COMISA early could help protect memory and reduce dementia risk.” 

Medline inks supplier agreement with Coastal Bend DME 

NORTHFIELD, Ill. – Medline has signed a supplier agreement with Texas-based Coastal Bend DME, a locally owned and operated durable medical equipment (DME) and supply company serving communities in South Texas. The agreement provides Coastal Bend DME with access to Medline’s expansive product portfolio and next-day delivery capabilities, supporting Coastal Bend DME’s provision of home care and DME to patients. “We are thrilled to solidify our relationship through this new agreement,” said Britt Murray, post-acute care sales representative, Medline. “This deal formalizes our commercial relationship, enables drop shipping and leverages our Medline Home Direct program to deliver single-patient orders directly to residences.” Coastal Bend is serviced out of Medline’s distribution center in Katy, Texas, part of its national network of 45 distribution facilities that help enable next-day delivery to 95% of U.S. customers. The companies say the collaboration will help improve both the availability and accessibility of high-quality medical supplies, including incontinence items, enteral nutrition and DME, for Coastal Bend DME’s patients. “Partnering with Medline allows us to expand our product offerings and better serve our clients with reliable and innovative medical supplies,” said Raymond Salloum, owner of Coastal Bend DME. “We’re excited about this formalized agreement, which brings competitive pricing and streamlined logistics to our operations, ultimately benefiting the communities we serve.” 

Medtronic rolls out MiniMed 780G insulin pump system with Instinct sensor in US 

GALWAY, Ireland – Medtronic has announced the broad U.S. commercial launch of the MiniMed 780G insulin pump system integrated with the Instinct sensor, made by Abbott and designed exclusively for MiniMed systems. The Instinct sensor is based on Abbott's most advanced continuous glucose monitoring (CGM) technology, featuring a small discreet sensor with a wear time of up to 15 days. When paired with the MiniMed 780G system, the Instinct sensor provides real-time glucose readings, which the system uses to automate insulin adjustments every five minutes. "This milestone marks an important next step in our work to bring the proven clinical outcomes of our MiniMed 780G system to more people living with diabetes," said Que Dallara, EVP and president of Medtronic Diabetes. "With this launch, we're expanding a smart dosing ecosystem built for choice, so every person can find a solution that fits their life. We exist to make life with diabetes easier and more predictable, so people living with diabetes can enjoy greater freedom and better health every day. Our goal is to deliver confidence and peace of mind, so everyone – including loved ones – can live boldly without compromise." In September, Medtronic received clearance from the U.S. Food and Drug Administration (FDA) for its SmartGuard algorithm as an interoperable automated glycemic controller (iAGC), enabling integration with Abbott’s Instinct sensor for Type 1 diabetes. The company has also received approval of the MiniMed 780G system for use in adults 18-plus with insulin-requiring Type 2 diabetes.  

AOPA, IIOP to partner on business certificate program 

ALEXANDRIA, Va. – The American Orthotic and Prosthetic Association (AOPA) has announced that, beginning in the fall of 2026, the International Institute of Orthotics & Prosthetics (IIOP) will become the new partner for its Business Certificate Program. Since 2021, AOPA has offered this comprehensive, non-degree certificate program to strengthen business and leadership skills across the orthotics and prosthetics (O&P) profession. “AOPA is thrilled to partner with IIOP to expand and enhance this important program,” said Teri Kuffel, JD, AOPA executive director. “As the O&P profession continues to evolve, strong business leadership is essential. This partnership will strengthen the educational experience, broaden access and ensure that O&P professionals gain the strategic knowledge necessary to thrive in their businesses.” Designed for patient care facility owners, managers, practitioners, manufacturers, distributors and administrative staff, AOPA says the program equips participants with tools to navigate today’s most pressing business challenges, including finance, sales and marketing, operations and management. More details about registration, course availability, and timelines will be shared in early 2026. 

New York updates CRT maintenance, repair policies 

ALBANY, N.Y. – The state of New York will cover preventative maintenance for all primary power wheelchairs (PWCs) that are less than five years old, effective Jan. 1, 2026, for fee-for-service (FFS) and March 1, 2026, for managed care, the National Coalition of Assistive and Rehab Technology (NCART) has reported. The state will also cover Group 2, Group 3, Group 4, Group 5 and Group 6 power wheelchairs with or without power options for use as a backup PWC when the user has been provided with a new, primary PWC, effective Jan. 1, 2026, for FFS and March 1, 2026, for managed care, in limited instances. Last year, a bill passed in the Tennessee General Assembly that provided “model legislation” for securing coverage and payment for preventative maintenance for PWCs and paved the way for a larger effort on repair reform, NCART and other stakeholders said.   

• See the NY preventative maintenance policy update here. 
• See the NY backup wheelchair policy update here.