Simplicity is a virtue.

From Washington, DC,

• Congress remains on the campaign trail this week.

• Beckers Hospital Review reports,
  • :CMS is pitching new guardrails for pharmacy benefit managers and Medicare Advantage plans under a proposed rule released Oct. 16.
  • “The proposed rule would implement sections of the Consolidated Appropriations Act of 2026. Comments are due Dec. 15.
  • “Starting Jan. 1, 2028, PBMs and their affiliates would only be able to accept flat-dollar, itemized service fees for Part D drugs. The fees could not depend on drug prices or rebates. Manufacturer rebates and discounts would remain allowed if they are fully passed through to the plan sponsor.” * * *
  • “Beginning in contract year 2028, MA organizations would need to estimate “a letter grade” for their provider directory accuracy based on a provider sample. In 2029, CMS would publicly post these scores, and plans would need to show them in their directories.
  • “If an MA enrollee books a provider listed as in network, that enrollee would pay no more than the lesser of the in-network or other cost-sharing. This would still apply if the provider ends up being out of network. That protection would begin in contract year 2028.”

• The American Hospital Association News tells us,
  • “The Centers for Medicare & Medicaid Services announced that it will exercise enforcement discretion for inpatient rehabilitation facility admissions from Oct. 1, 2026 through March 31, 2027, with respect to the timing of the initial interdisciplinary team meeting requirement. As of Oct. 1, the initial IDT meeting must occur on or before four days from the date a patient is admitted to an IRF in order to implement appropriate treatment services; establish or review the patient’s stated rehabilitation goals; and identify problems that could impede those goals. This requirement was finalized in the fiscal year 2027 IRF prospective payment system final rule. The AHA had urged CMS not to finalize this requirement, in part due to its inconsistent descriptions of when the four-day threshold would be met relative to admission. 
  • “During this six-month moratorium, Medicare Administrative Contractors will enforce the initial IDT meeting timing requirement that had been in effect during FY 2026. This means they will not deny or non-affirm a claim based solely on the timing of the initial IDT meeting if an IDT meeting occurs at least once per week throughout the duration of a patient’s stay. CMS said that all other applicable IRF coverage and documentation requirements remain in effect.” 

From the U.S. Office of Personnel Management front,

• The FEHBlog has noticed that 2027 FEHB and PSHB brochures are beginning to shown up in downloadable form on plan open season websites.

• OPM posted in the Federal Register a Paperwork Reduction Act notice about its efforts to extend its Postal Service Health Benefits Program portal for collecting family member documentation to the FEHB Program. The public comment deadline is December 18. 2026.

• OPM’s Office of Inspector General posted its Top OPM Management challenges for the current 2027 federal fiscal year.

No Surprises Act News

• The American Hospital Association News reports,
  • “The Centers for Medicare & Medicaid Services announced that the submission period opened Oct. 16 for petitions to deny the recertification of five independent dispute resolution entities. Members of the public, providers, facilities and others can submit a petition, which must identify the IDR entity seeking recertification and detail the reasons for the petition. The five organizations seeking recertification are Maximus Federal Services, Inc.; ProPeer Resources LLC; C2C Innovative Solutions, Inc.; Medical Evaluators of Texas ASO, LLC; and Federal Hearings and Appeals Services, LLC. The petition period is open through Oct. 23. The departments of Health and Human Services, Labor, and the Treasury will make a final decision on recertification after reviewing any petitions submitted.” 

From the judicial front,

• Beckers Hospital Review reports,
  • “AbbVie, Bristol Myers Squibb, Boehringer Ingelheim and PhRMA are asking to intervene in the hospital industry’s lawsuit seeking to block HRSA’s revised 340B Rebate Model Pilot Program, according to court filings in the U.S. District Court for the District of Maine.
  • “AbbVie and its Pharmacyclics unit, Bristol Myers Squibb and Boehringer Ingelheim filed a motion to intervene Oct. 14, and PhRMA filed its own motion Oct. 15 in American Hospital Association v. Kennedy. The drugmakers said they want to defend the rebate plans HRSA approved for their drugs, including AbbVie’s Imbruvica, Linzess and Vraylar, Bristol Myers Squibb’s Eliquis and Pomalyst and Boehringer’s Jardiance, Ofev and Tradjenta. They argued that the government’s representation of their interests “may be inadequate,” the standard for intervening, because, unlike HRSA, they face duplicate discount losses and civil penalties.”

From the public health and medical/Rx research front,

• Beckers Clinical Leadership reports,
  • “The share of flu tests coming back positive rose from 3.9% to 5% in the week ending Oct. 10, the CDC’s first FluView report of the 2026-27 season shows. ED visits and outpatient visits for flu also climbed.
  • “Seasonal flu activity remains low, but test positivity, outpatient visits for flu-like illness, ED visits with a flu diagnosis and lab-confirmed hospitalizations have all been rising since late August or early September. Activity is highest on the West Coast, and the CDC said early-season levels are higher than typical for this time of year but within expected seasonal variation. Influenza A(H1N1) accounted for 96.4% of the influenza A viruses that public health labs subtyped during the week.”

• Health Day relates,
  • “Poorer maternal dietary quality is associated with infantile colic and eczema, according to a study published online Oct. 12 in JAMA Network Open.
  • “Emily Oken, M.D., M.P.H., from Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston, and colleagues estimated associations of maternal diet quality and intakes of specific allergenic foods with infant eczema and colic in a prospective cohort of 2,128 mother-child pairs unselected for atopic risk. Food frequency questionnaires were administered in early and mid-pregnancy, and the Mediterranean Diet Score (MDS) and Dietary Inflammatory Index (DII) were calculated.”
• and
  • “If you’re in your 60s, 70s or even older, you might think your days of productively pumping iron are behind you.
  • “That’s just not true, said Dr. Adil Ahmed, an assistant professor in the Joseph Barnhart Department of Orthopedic Surgery at Baylor College of Medicine in Houston.
  • Building and maintaining muscle is a great way to stay all-round healthy, he said.
  • “The protective effect of muscle and muscle mass has been well studied — everything from the musculoskeletal system to orthopedics and even brain health,” Ahmed said in a Baylor news release. “Building muscle in your body has been well shown to delay dementia and the effects of dementia and preserve cognitive function.”
  • “Strength training also helps your bones. It’s one of the best ways to help aging bones stay dense and strong, Ahmed said.
  • “It’s a very good protective long-term process,” he said.” 

• MedPage Today points out,
  • “An oncologist who has taken care of patients with breast cancer for 25 years shared what she learned from having the disease. (NBC News).
  • “Delays in breast cancer diagnosis and treatment occurred significantly more often in young women, a cohort study found. (Cancer).”

From the U.S. healthcare business front,

• Modern Healthcare tells us,
  • “Health systems are increasingly selling their real estate to ease financial pressure and fuel expansion, and regulators are pushing back.
  • “Health systems are seeking relief from higher costs and lower reimbursement by selling the buildings and land that house their hospital and outpatient facilities. Those deals provide an immediate capital infusion to shore up finances and fund growth, but can expose providers to higher long-term costs as buyers become more selective and state and federal policymakers increase oversight. 
  • “This is trading a short-term fix for a long-term cost,” said Jim Baker, founder and executive director of the Private Equity Stakeholder Project, a nonprofit watchdog group that opposes private equity investment in healthcare.” 

• BioPharma Dive reports,
  • “Estuary Biotherapeutics, a California-based genetic medicines developer, officially launched on Friday, backed by nine figures worth of funding and a management team stocked with former Biogen leaders.
  • “Forged in 2022, Estuary is built around research conducted by its scientific co-founders Stefan Somlo and Michael Caplan, both professors at the Yale School of Medicine. Somlo’s lab has made major discoveries about an inherited disorder where certain genetic mutations cause cysts that progressively damage the kidneys and often lead to renal failure. Through a landmark study published in the journal Nature Genetics, Somlo’s team found that, in mice, reactivating proteins called polycystins could shrink the cysts and reverse kidney inflammation and scarring.
  • “And in Caplan’s lab, scientists determined that only a small piece of the full polycystin protein is needed to suppress this “autosomal dominant polycystic kidney disease.” Those findings suggest that helpful genetic material can be successfully packaged up and delivered to the kidneys with the standard “viral vectors” used for gene therapy.
  • “Taken together, Estuary believes its technology and expertise will bring about the first-ever treatment that can halt or reverse, rather than just slow, the most common inherited kidney disorder. Estimates hold that ADPKD affects about 1 in every 400 to 1,000 people. Just one drug, tolvaptan, is specifically approved to treat it.”

• Fierce Pharma offers us a look inside “Teva’s Weltruza launch and Novo’s GLP-1 strategy.”