KORY STUER

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPSs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0.

ACPSs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPSs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPSs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPSs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPSs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPSs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPSs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPSs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPSs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPSs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.