The government is still shutdown, and DC feels it. Agencies are working from contingency playbooks and grant clocks are pausing or slipping. The path to a clean FY26 appropriations package or CR is murky, and stakeholders are adjusting plans in real time.

In this week’s Nimitz Health:

• Federal News: Shutdown operations, pharma tarriffs, and IVF conversations

• State News: Medicaid waivers and rate moves and notable AG actions

• Industry News: Payer and PBM maneuvers and domestic manufacturing plans

WHO’S HAVING EVENTS THIS WEEK?

Wednesday, October 22nd

• *Senate Aging: “Hearings to Examine Modernizing Health Care, Focusing on how Shoppable Services Improve Outcomes and Lower Costs.” at 3:30pm. Watch here.

Thursday, October 23rd

• *Senate HELP: “Hearings to Examine the 340B Program, Focusing on Examining its Growth and Impact on Patients” at 10am. Watch here.

• Senate EPW: “Hearings to Examine the Beneficial Use and Regulation of Chemicals” at 10:30am. Watch here.

*Will be covered by Nimitz Health. Please email [email protected] if you would like a readout of any other hearings.

NEWS DRIVING THE WEEK

Federal News

The government shutdown remains the center of gravity in DC. Senate Republicans are dangling a “vote later” on ACA subsidies to reopen the government, while Democrats insist the extension must be part of any funding bill now. With the Senate rejecting short-term patches repeatedly and the House largely out, leaders on both sides are framing the stalemate around whether to extend the enhanced Obamacare tax credits before open enrollment begins Nov. 1. The Senate will vote for the omnibus for the 11th time today at 5:30pm ET. See live government shutdown updates here.

Meanwhile, policy spillovers are widening. CMS is withholding Medicare payments for certain telehealth visits tied to pandemic-era flexibilities that lapse without a funding vehicle, and hospitals are pausing “hospital-at-home” programs after the waiver linked to spending bills expired, pushing patients back into inpatient beds ahead of flu/RSV season. Provider groups are urging Congress to detach multi-year extensions for these programs from the shutdown fight to restore continuity.

The UK is nearing a pricing and tariff arrangement with the White House that would lift NHS outlays for select medicines in exchange for low to zero US tariffs on UK pharma exports. London has floated raising the NHS cost-effectiveness threshold by up to 25 percent while US negotiators may still press for a 10 percent tariff and a larger UK spend on innovative drugs. Talks are advanced but not final.

Separately, the Trump administration announced IVF moves: a cash-price cut of 42–79% for Gonal-F via a new TrumpRx channel next year, expedited FDA review for Pergoveris, and guidance to ease stand-alone employer fertility benefits, without new federal funding or coverage mandates. The steps drew mixed reactions amid simultaneous workforce and data cuts at HHS divisions involved in reproductive medicine.

On oversight and operations, ICE is hiring more than 40 clinicians for detention sites as reported deaths in custody climb and watchdogs warn oversight has thinned amid agency layoffs and access limits for visiting lawmakers. Health groups say extra staff could reduce medication delays but caution deaths may continue without broader policy changes.

State News

States are already bracing for subsidy uncertainty. Marketplace directors say every day of delay increases the odds they can’t update rates in time. Some have printed notices warning consumers of higher premiums while preparing contingency plans if Congress acts in November, December, or even January, which could force enrollees to front a higher first-month bill before tax reconciliation. Idaho opened early on Oct. 15; most states start Nov. 1.

In New York, rural providers are shaping the state’s application for a $50 billion federal Rural Health Transformation program due Nov. 5, prioritizing workforce, transportation and technology (including broadband for telehealth). Smaller hospitals fear funds could flow to large systems. Half of the pot would be split evenly among states, with the rest at CMS’ discretion, raising stakes for how Albany frames its bid amid tense federal–state dynamics during the shutdown.

Industry News

On pricing, AstraZeneca struck a White House deal: most-favored-nation pricing for Medicaid, participation in the TrumpRx direct-purchase platform, and a three-year tariff reprieve tied to domestic manufacturing plans. This is part of a series of bilateral agreements the administration says will also influence list prices on new launches. Watch for operational details from the company on which drugs land on the DTC platform.

FOR FUN

Happy Diwali to all who celebrate! Here is more information on the holiday for anyone unfamiliar/curious.

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