Texas Legislature Begins 2025 Legislative Development

December 10, 2024

EGWP marketplace medicaid Medicare

Texas lawmakers have started filing bills in preparation for the upcoming 2025 Legislative Session, even though the session does not begin until mid-January. As of this week, thousands of bills have already been filed, including bills seeking to address artificial intelligence, telehealth, abortion rights, health benefit mandates, immunizations, and drug coverage. Several bills have also been filed to expand Medicaid health insurance coverage in the state, an issue that is considered unlikely to gain traction despite how much federal funding it would unlock.

GOP leadership has been steadfastly opposed to any expansion of Medicaid, which currently covers mostly children, disabled individuals, and older adults. Texas is expected to have plenty of cash to fund any new mandates, education, and existing Medicaid expenses. State Comptroller Glenn Hegar projected that the state would have a $20 billion surplus at the start of 2025.

legislation

Virginia and Hawaii Introduce PDAB Legislation

The Virginia Senate introduced a bill to establish a Prescription Drug Affordability Board (PDAB) to review drugs with a wholesale acquisition cost (WAC) of $60,000 or more per year or a WAC increase of $3,000 or more in any 12-month period. For drugs deemed to cause an affordability challenge, the legislation authorizes the PDAB to […]
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February 12, 2026

EGWP marketplace medicaid Medicare

Solutions

AHIP Shares Update on Plan Progress to Simplify Prior Authorization

AHIP shared progress on the voluntary, multi-year commitments made by AHIP, BCBSA, and leading health plans (including Cigna Healthcare) to streamline and simplify prior authorization. Health plans serving nearly 270 million Americans are participating in this initiative. The 2026 commitments took effect on Jan. 1 and include: reducing the scope of claims subject to prior […]
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February 12, 2026

EGWP marketplace medicaid Medicare

legislation

DOL Issues Proposed Rule on Improving Transparency into PBM Fees

Pursuant to President Trump’s Executive Order “Lowering Drug Prices by Once Again Putting Americans First,” the Department of Labor’s (DOL’s) Employee Benefits Security Administration (EBSA) issued a proposed rule that would require providers of PBM services and affiliated entities of brokerage and consulting services to disclose direct and indirect compensation to their self-funded ERISA fiduciary […]
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February 12, 2026

EGWP marketplace medicaid Medicare

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