Why it matters: The sweeping changes to Medicaid and the Affordable Care Act, the upending of the vaccine system, and new ways people purchase drugs foreshadow the most significant changes to health markets since the passage of Obamacare.

Here are some of the top storylines we’ll be watching:

Health care costs: Health insurance premiums are surging in ACA markets, thanks to the expiration of enhanced subsidies, and for workplace coverage. Drugmakers are raising prices for hundreds of medicines, despite President Trump’s strong-arming.

• The question is whether Republicans can even agree on what to do about an issue that’s ratcheting up voter anxiety.
• Their first chance will come this month in the run-up to the government funding cliff, when there’s the opportunity to use a spending deal to retroactively extend the Obamacare subsidies for about 20 million patients, many of whom live in red states.
• The other option would be for the GOP to go it alone with another megabill filled with conservative ideas aimed at lowering health care costs. While that could help endangered incumbents, it would mean another draining health care debate without a clear path for passage.

Medicaid: This is the year when states will have to implement the changes that congressional Republicans passed in last summer’s tax-and-spending law — and it’s not clear that they’ll be ready.

• Among other things, they have just one year to build and test systems to make sure able-bodied recipients are working at least 80 hours a month and gather supporting data for people who are exempt.
• The millions more uninsured Americans arising from all of the changes are expected to drive up unreimbursed care costs for hospitals and threaten those with shaky finances.

Vaccine restrictions: More regional outbreaks of measles, whooping cough and other vaccine-preventable diseases could test the Trump administration’s resolve to adopt a new childhood vaccine schedule, especially without going through an established rulemaking process.

• The FDA has also signaled it may impose tougher requirements on new vaccines and the annual flu shot, which medical professionals say would make it impossible to test and manufacture a vaccine in time for each year’s flu season.
• And Health Secretary Robert F. Kennedy Jr. wants to revamp the federal liability protections that shield drug manufacturers from being sued for vaccine-related injuries.

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Another reprieve for COVID-era teleprescribing

By Caitlin Owens

Illustration: Gabriella Turrisi/Axios

Pandemic-era telemedicine flexibilities around the prescribing of controlled substances have been extended yet again, HHS announced Friday. Why it matters: The extension — the fourth of its kind — will allow patients to receive prescriptions for medicines like attention-deficit/hyperactivity disorder and opioid use disorder treatments via telehealth without a prior in-person visit through the end of 2026. In 2024, more than 7 million prescriptions for controlled medications were issued without a prior in-person visit, HHS said, suggesting that an abrupt expiration of the federal flexibilities could have an enormous patient impact. What we’re watching: This extension gives the Drug Enforcement Administration “additional time to finalize permanent regulations,” per the announcement. The big picture: If there was any clear winner during the pandemic, it was telehealth, which emerged with strong bipartisan support. But permanent regulation surrounding controlled substances is aiming to balance patient access with preventing misuse of such medications. Some patients have grappled with shortages of Adderall and other amphetamines like Vyvanse used for ADHD. Behavioral health providers say access would be further disrupted if old limits on telehealth prescribing were restored. from STAT: obesity Novo launches Wegovy pill, undercutting Lilly in DTC market Novo Nordisk today launched its newly approved obesity pill and it’s laser focused on grabbing market share in the direct-to-consumer market. As we wrote last week, the Danish company will sell the highest doses of the Wegovy pill at $299 a month for patients buying it directly. Meanwhile, Eli Lilly has said it plans to sell its pill orforglipron at up to $399 a month following approval, which is expected in the next few months. At the same time, however, Novo will maintain the same list price for the Wegovy pill as the injection, $1,349 a month, the company told STAT. That means the pill may not necessarily be cheaper than injections for patients getting their weight loss drugs through insurance. Patients typically have to pay the list price of drugs before meeting their deductibles, or, if they have to pay co-insurance, then they pay a certain percentage of the list price. Read more.