By Megan R. Wilson

In today’s issue:

• Exclusive: Top Democrats are demanding unredacted copies of the Trump administration’s drug-pricing deals, setting up an oversight fight next year
• Rural Health Transformation Program funding is shifting in the program’s second year, with at least 20 states seeing their awards decline and roughly 17 receiving a boost
• Three biotech groups are suing over the Trump administration’s plan to tie Medicare drug prices to those paid abroad, adding to a legal fight already underway

Welcome back to Health Brief. I’m your health policy host, Megan Wilson. Congress is finally back in Washington after the midterm elections, and new members are heading to orientation. There are just 17 legislative days until the government funding deadline — but some Republicans are urging their colleagues to put in overtime during the lame-duck session.

Mea culpa: In Friday’s newsletter, I incorrectly wrote that Rep. Lloyd Doggett (D-Texas) was a member of the House Energy and Commerce Committee when I meant House Ways and Means Committee.

Do you have any health care tips? Are you attending tonight’s Make America Healthy Again event? I want to hear from you. Shoot me a note at megan.wilson@washpost.com, or send a secure message on Signal to megan.434.

Did someone forward this newsletter to you? Sign up here to get it in your inbox.

In 2019, Pfizer CEO Albert Bourla testified before the Senate Finance Committee during hearing on drug prices in 2019. In 2025, Pfizer was the first drugmaker to announce cutting a drug-pricing deal with the Trump administration.(Pablo Martinez Monsivais/AP)

Let the oversight begin. Top Democrats on congressional health committees are pressing drugmakers for the fine print on their most-favored-nation (MFN) deals with the Trump administration, according to a person directly familiar with the matter who spoke on the condition of anonymity to discuss sensitive details.

Reps. Frank Pallone Jr. (D-New Jersey), Richard Neal (D-Massachusetts) and Bobby Scott (D-Virginia), along with Sen. Ron Wyden (D-Oregon) have sent emails to all 27 companies that have struck deals with the administration, demanding that they immediately turn over unredacted copies of the agreements.

If the companies — which include Pfizer, AstraZeneca, Eli Lilly, Novo and Genentech — can’t produce the records right away, the lawmakers want them to set aside time in the next two weeks to discuss how they plan to fulfill the request, the person said.

Why it matters: The correspondence signals an early oversight fight for the next Congress that starts in January. The email directive is an indication of a key area Democrats plan to focus on while in the new majority — when they have the power to demand documents, hold hearings and pursue investigations into the administration’s health policies.

Pallone, Neal and Scott are positioned to hold gavels of the House Energy and Commerce, Ways and Means and the Education and the Workforce Committees, respectively, while Wyden is expected to lead the Senate Finance Committee.

Democratic lawmakers have been vocal about wanting to know more about the deals, which both Trump administration officials and company executives have said are confidential, in part because they contain sensitive business information.

In March, the same four Democrats sent President Donald Trump a letter that asks for more details about the deals, which have become a key part of Trump’s health care agenda. Democrats say the lack of disclosure makes it impossible to assess whether the deals deliver the savings that the administration has promised.

The Trump administration is sending another $10 billion to states for rural health care, but the second round of awards comes with some changes in how much money is distributed in certain places.

This is part of the $50 billion Rural Health Transformation Program established in Republicans’ sweeping domestic policy law enacted last year, and aimed to offset some of the cuts to the Medicaid program through 2030.

→ Seventeen states will receive at least 1 percent more money from the program in fiscal 2027 than they did in the first year, while 20 states will see their awards decline by at least 1 percent, according to my tally of the allocations by the Centers for Medicare and Medicaid Services. Thirteen states had smaller changes to their allocations in either direction.

The National Rural Health Association said states have been “emphasizing workforce, rural hospital and health-system sustainability, technology, innovative payment and service models, and disease prevention.”

“The priority is to ensure these investments produce long-term delivery system change — not simply short-term projects — for rural providers and the patients they serve,” the group said in its statement.

Increases: North Dakota will see the largest increase (4 percent), gaining more than $7.4 million to reach a total of $206.4 million. Iowa will receive an additional $7 million, while Montana and Virginia will each gain approximately $6.2 million more this year.

West Virginia Gov. Patrick Morrisey (R) said his state’s $202 million — a $2.6 million, or 1.3 percent, increase over fiscal 2026 — will “help us expand access to care, strengthen rural hospitals, and address the chronic health challenges facing West Virginia.”

The state received the 25th largest amount, equal to roughly $204 per rural resident. (It’s a jump from the $154 per rural resident allocation in fiscal 2026.)

“We set out to put every dollar of our first-year award to work, and we got it done ahead of schedule,” Morrisey said in a statement, noting that West Virginia signed 145 awards and agreements to disburse the money across all 55 counties. “Now we’re building on that momentum.”

Read more: When the first round of funding was announced in January, I wrote about the breakdown of the funds and compared it for each state’s rural population.

Decreases: Florida will lose the most funding in dollar terms, with its award falling $6.1 million compared to fiscal 2026, to $203.8 million. New Jersey will see the steepest percentage decline, with its allocation dropping 3.3 percent to $142.3 million. Vermont and New Jersey will each see reductions of about $5 million.

Unpacking the changes: Half of the program’s annual $10 billion is divided equally among the 50 states, giving each $100 million every year for five years. The remaining half is distributed based on factors including rural health needs, state initiatives and policy decisions.

CMS said that it reviewed annual progress reports from all 50 states detailing how they implemented the first round of funding. The agency also considered states’ progress on certain policies favored by the administration, including bringing back the Presidential Physical Fitness Test in schools and requiring physicians to complete continuing medical education on nutrition.

→ The announcement is coming later than expected, and KFF Health News reported about the reasons for the delay last week. The outlet also reported that several states were concerned about the burdensome reporting requirements amid tight deadlines.

Three biopharmaceutical industry groups are suing the Trump administration over its experimental model to tie prices for drugs in the Medicare Part B program to what other wealthy countries pay.

The Biotechnology Innovation Organization, Biocom and California Life Sciences filed suit on Friday, challenging what’s known as the Global Benchmark for Efficient Drug Pricing (GLOBE) model.

“For nearly a decade, Congress has considered — and repeatedly rejected — legislation tying American drug prices to foreign government price controls. Yet the Executive Branch now claims unilateral authority to impose the policy Congress refused to enact,” begins the new complaint from the biotech industry groups.

CMS has previously said it doesn’t comment on pending litigation.

→ It comes a month after Pharmaceutical Research and Manufacturers of America (PhRMA), a major industry group for drugmakers, challenged GLOBE in the U.S. District Court for the District of Columbia.

Like PhRMA, the lawsuit from this trio of biotech groups also raises constitutional objections to the GLOBE model, including arguing that CMS is making policy and spending decisions that belong to Congress.

The groups, which also argue that the pilot program doesn’t benefit patients and would harm innovation, want the court to strike down GLOBE entirely.

If it’s allowed to continue, the groups say, CMS could vastly expand this limited, seven-year pilot.

“The agency’s decision to exempt particular products today supplies no enduring statutory limit on the power it asserts for tomorrow. The potential consequences of that broader authority are substantial,” the lawsuit reads.

→ In my October write-up on the PhRMA lawsuit, I pointed out the preemptive defense CMS made against the anticipated legal challenges when it finalized the GLOBE model.

Revisiting this quote: “We acknowledge that manufacturers may disagree with the GLOBE Model’s rebate methodology and may believe that the rebate obligations are excessive,” CMS wrote in the final rule. “However, disagreement with payment policy does not establish a constitutional violation.”

“White House staff gave Trump bad advice, treated him ‘like a baby,’ ex-aide says,” The Post’s Rachel Roubein writes.

“Medicare Advantage premiums are getting cheaper — but there’s a catch,” John Csiszar writes for The Post.

“RFK Jr. May Be Finding a Stronger Foothold in Trump’s Administration,” Paige Winfield Cunningham reports at the Washington Sun.

“The hospital hiding in a strip mall: Mon Marion Neighborhood Hospital in West Virginia is part of a burgeoning trend of micro-hospitals, diminutive facilities with less than 50 beds.,” reports Healthcare Dive’s Sydney Halleman.

Reuters’ Sneha S K reports that “FDA orders new eye risk warnings for Ozempic, Zepbound.”

This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from The Washington Post newsroom. Learn more about WP Intelligence.