The Congress reached a provisional budget agreement On Tuesday, it largely — but not entirely — reversed a 2.8 percent reduction in Medicare’s physician fee schedule and will expand some telehealth flexibilities and attempt to rein in pharmacy benefit managers (PBMs).

The deal, which still must pass the House and Senate, increases payments under the Medicare Physician Fee Schedule by 2.5 percent, more than offsetting the 2.8% reduction finalized by CMSbut still leaving doctors with a 0.3% payment reduction. However, it does not include the Law improving rapid access to care for the elderlywhich would have established an electronic prior authorization process for Medicare Advantage (MA) plans that would standardize transactions and clinical attachments, increase transparency around MA prior authorization requirements, and require HHS and other agencies report to Congress on their efforts to improve the electronic system. prior authorization process.

“MGMA (Medical Group Management Association) is pleased that Congress has heeded our call to extend telehealth flexibilities through the end of 2026 (and) increase APM (Alternative Payment Model) incentive payments to 3 .53%,” Anders Gilberg, the group’s senior vice president for government affairs, said in a statement. (Disclosure: Gilberg is a member of the Page Med today editorial committee.) “These are big wins for medical groups.” Telehealth flexibilities include removing geographic requirements and expanding the originating locations of telehealth services, as well as expanding the type of practitioners eligible to provide services via telehealth.

“On the other hand, we are deeply disappointed that Congress has failed to fully address the looming reduction in Medicare payments to physician offices in 2025,” Gilberg continued. “Any reduction, no matter how fractional, is unacceptable. Finally, not counting legislation to reform prior authorization, which has the support of a bipartisan majority in the House and Senate, nearly 500 party organizations stakeholders who support it… and with little or no opposition, this represents a huge failure for Congress at the end of the year and another victory for big insurance at the expense of American patients.

The Regulatory Relief Coalition, a group of specialty physician organizations that advocate for reducing Medicare’s regulatory burden, said it was “outraged” that the legislation was not included. “Our nation’s seniors are counting on Congress to act to restore their timely access to medically necessary health care,” the group said in a statement. “Unfortunately, this Congress is failing them by sidelining smart policy in favor of political wrangling. This colossal failure to respond to public outcry for better oversight and transparency of the master’s program is completely unacceptable.”

The tentative agreement also includes legislation to more closely regulate PBMs. Provisions include requiring PBMs to provide detailed drug spending data to group health plans, and also to pass on 100% of drug rebates and rebates to the employer or health plan for which they negotiate. The legislation also requires CMS to establish “reasonable” contract terms for Medicare Part D drug plans and to authorize “any voluntary pharmacy” to serve Medicare patients. It also prohibits PBMs from tying their compensation to the Medicare price of a drug.

Other elements of the agreement include:

• A 5-year reauthorization of Law of SUPPORTaimed at combating the opioid crisis
• A 5-year extension of the Teaching Health Center’s graduate medical education program, designed to augment the primary care workforce
• A provision to prevent cuts to the Medicaid Disproportionate Share Hospital program
• A 2-year reauthorization of the Pandemic and All-Hazards Preparedness Act

Sen. Ron Wyden (D-Ore.) praised the deal’s inclusion of “improvements to Medicare, particularly cracking down on ghost networks in Medicare Advantage that prevented seniors from finding a doctor or psychiatrist in their plan health”.

“There is still much work to be done to improve mental health care for all Americans, but making sure you can find a doctor when you need care is the first step,” he said in a press release.