In a closely contested vote of 215–214, the U.S. House of Representatives on Thursday approved President Donald Trump’s expansive tax reform package, known as the “One Big Beautiful Bill Act.” The bill, largely supported along party lines, will now proceed to the Senate for further consideration. GuideView notes that "All Democrats and two Republicans voted against Trump’s tax bill."
The legislation proposes notable changes to drug pricing regulations established under the Biden administration's Inflation Reduction Act. A key adjustment is the exemption of certain orphan drugs—specifically, those approved to treat more than one rare disease—from federal price negotiations. These changes are slated to come into effect in 2028, pending Senate approval.
"Trump’s tax bill excludes orphan drugs approved to treat more than one rare disease from negotiations."
The bill also targets the controversial pricing practices of pharmacy benefit managers (PBMs). One significant provision prohibits spread pricing, a model in which PBMs charge payers such as Medicare more for medications than they reimburse to dispensing pharmacies—retaining the margin as profit.
"Trump’s One Big Beautiful Bill Act also puts some limits on pharmacy benefit managers, prohibiting a common practice called spread-pricing..."
Notably absent from the bill is a correction to the so-called “pill penalty”—a disparity in the negotiation exclusion periods between small-molecule drugs and biologics. This omission is particularly striking given President Trump’s previous support for removing this penalty via executive order.
"Conspicuously missing from the act, however, are adjustments to the pill penalty..."
On the same day, the White House released its nearly 70-page “MAHA” report—short for "Make America Healthy Again"—aimed at improving childhood health outcomes. The document serves as a policy roadmap for the Department of Health and Human Services, outlining a strategy to address what it terms the “childhood chronic disease crisis.”
"The report ‘provides [the] foundation’ for the Department’s mission ‘to make our children healthy again’..."
The MAHA report criticizes what it calls the “overmedicalization” of children, pointing to excessive prescription practices and the influence of industry interests on regulatory bodies. It specifically cites the pharmaceutical industry’s lobbying expenditures from 1998 to 2018 as indicative of a broader issue of corporate influence.
"There is a concerning trend of overprescribing medications to children," the report reads, blaming this pattern on “conflicts of interest in medical research, regulation, and practice.”
While acknowledging the protective benefits of immunization, the MAHA report also emphasizes the need for balanced evaluation of side effects, particularly with regard to the expanding childhood vaccine schedule. It proposes a stronger post-marketing surveillance system and calls for long-term studies on the neurodevelopmental and metabolic outcomes of commonly prescribed pediatric medications.
"The report recommends several initiatives, including launching a robust post-marketing surveillance mechanism for real-world safety findings..."
