{"id":10195,"date":"2025-11-03T11:32:08","date_gmt":"2025-11-03T16:32:08","guid":{"rendered":"https:\/\/www.appliedpolicy.com\/staging\/7403\/?p=10195"},"modified":"2025-11-21T11:33:20","modified_gmt":"2025-11-21T16:33:20","slug":"dr-oz-outlines-cms-priorities-at-aspen-institute-event","status":"publish","type":"post","link":"https:\/\/www.appliedpolicy.com\/staging\/7403\/dr-oz-outlines-cms-priorities-at-aspen-institute-event\/","title":{"rendered":"Dr. Oz Outlines CMS Priorities at Aspen Institute Event"},"content":{"rendered":"

On October 6, 2025, The Health, Medicine & Society Program of the Aspen Institute hosted Public Health Grand Rounds with Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (CMS). Following initial remarks, Dr. Oz was interviewed by Bertha Coombs, CNBC Senior Health Care Reporter, to discuss the direction of the agency under Oz\u2019s leadership. A recording of the event can be found here<\/a>.<\/p>\n

In initial remarks, Dr. Oz noted the importance of getting ahead of issues instead of just relying on rulemaking and legislation, such as efforts made in the prior authorization space and with Most Favored Nation (MFN) drug pricing. He also noted a persistent disconnect between providers and patients, underscoring the need for honesty and transparency in addressing health challenges. A summary of key takeaways from this event are highlighted below.<\/p>\n

Leadership and Policy Direction<\/h3>\n

Dr. Oz praised President Trump\u2019s leadership in setting an agenda, driving progress, and fostering collaboration between the public and private sectors. Dr. Oz specifically noted the June announcement[1]<\/a> of an industry pledge to reform the prior authorization system by health insurance companies, covering roughly 80% of the healthcare sector, and stated that there are similar collaboration and reform efforts in drug pricing policy.<\/p>\n

Chronic Disease<\/h3>\n

Dr. Oz noted that CMS is working to address chronic disease, in part, through the Make America Healthy Again (MAHA) movement. He also mentioned that the U.S. Department of Agriculture (USDA) and the Centers for Disease Control and Prevention (CDC) are collaborating on efforts to address obesity and lifestyle-related conditions. Dr. Oz noted that in terms of obesity, there are opportunities with current GLP-1 medications and pill-based versions that are emerging, but that these alone are not enough to address the underlying causes of obesity.<\/p>\n

GLP-1s<\/h3>\n

Dr. Oz declined to provide specifics when asked about making GLP-1s available for weight-loss treatment under Medicare, noting \u201cwe\u2019re in the middle of a lot of action in that space,\u201d and that \u201cyou\u2019ll be hearing more about it very soon.\u201d He further noted that there are multiple policy options currently under consideration and that CMS is working to find \u201cthe right way to do it.\u201d<\/p>\n

Certain GLP-1 medications have been selected for Medicare Drug Price Negotiations.[2]<\/a> When asked about any updates in this space, Dr. Oz noted that the negotiations that occur in accordance with the Inflation Reduction Act (IRA) aim to secure pricing that is protective without discouraging innovation. Dr. Oz reported that 15 additional drugs are now entering the negotiation process and that the negotiation team has been working aggressively, with results expected within the next month.<\/p>\n

Government Shutdown and the Affordable Care Act<\/h3>\n

Dr. Oz noted that CMS aims to ensure out-of-pocket costs remain stable despite the shutdown, recognizing that premium rates are already set by insurers and cannot be rolled back immediately. Furthermore, Dr. Oz noted that CMS can adjust what enrollees actually pay after subsidies once government operations resume. Dr. Oz emphasized that a clean continuing resolution is needed to restore operations and address these issues.<\/p>\n

Medicare Advantage<\/h3>\n

Dr. Oz acknowledged his initial enthusiasm for \u201cMedicare Advantage (MA) for All,\u201d but now sees the challenges in cost and structure. CMS\u2019s goal is to increase competition and patient choice while addressing the higher federal spending on MA plans. CMS has engaged MA plans directly to identify solutions and pursue a regulatory middle ground. CMS intends to encourage plans to comply with directives, otherwise action may be taken against plans. As an example, Dr. Oz cited streamlined prior authorization reforms, such as providers submitting key procedure codes by end-of-year and allowing instant adjudication starting next year.<\/p>\n

Medicaid Work Requirements<\/h3>\n

With regards to rising costs across the healthcare sector (Medicare, Medicaid, and commercial plans), Dr. Oz expressed optimism about progress in cost control and transparency. He stressed that \u201cthere is no cut to Medicaid,\u201d but the growth in terms of financial expenditures will not be as high as it would have been previously. Dr. Oz also advocated work requirements to promote engagement and sustainability, arguing they encourage productivity and healthier lifestyles as well. When asked about how CMS will help states make sure beneficiaries are aware of changes and the burdens they may face due to these new work requirements, he noted CMS is exploring ways to improve coordination between community health centers and hospitals to better support beneficiaries. Dr. Oz added that CMS is exploring different technology platforms to help states identify an enrollee\u2019s work requirements. CMS aims to include volunteer and educational activities under work requirements.<\/p>\n

Drug Pricing and Innovation<\/h3>\n

Dr. Oz discussed the MFN pricing model which aims to lower U.S. drug costs while preserving innovation. Dr. Oz denied that the policy simply shifts costs between sectors, citing specific deals such as the recently announced one with Pfizer,[3]<\/a> as examples of nuanced pricing strategy. He acknowledged concerns about maintaining U.S. innovation but emphasized that the MFN structure is designed to protect research and development (R&D) incentives and innovation while lowering excessive prices.<\/p>\n

In further discussion about international pricing, Dr. Oz noted a long-standing imbalance where European countries and other nations \u201cfreeload\u201d off U.S. pharmaceutical innovation. He explained that U.S. consumers and payers have shouldered the global cost of R&D, allowing other nations to negotiate lower prices. CMS and the administration aim to recalibrate this imbalance through new pricing policies.<\/p>\n

Insurance Marketplace and Artificial Intelligence<\/h3>\n

Dr. Oz stressed CMS\u2019s goal to keep people insured and improve quality. He highlighted the need for bipartisan cooperation and a long-term funding strategy beyond short continuing resolutions. Dr. Oz also advocated fordigital transformation, quality metrics, and artificial intelligence (AI) integration to improve efficiency and care customization, particularly in rural areas. He emphasized that AI is a tool to augment\u2014not replace\u2014providers and to enhance fraud prevention and efficiency.<\/p>\n

When asked more generally about AI incorporation, Dr. Oz noted that ensuring HIPAA compliance is a key priority. AI is viewed as a resource to improve efficiency, particularly in areas like billing and prior authorization. He also noted the potential for AI to streamline operations and support providers, making care delivery more effective.<\/p>\n

Rural Health and the Workforce<\/h3>\n

The Rural Health Transformation Program (RHTP) is designed to support rural healthcare innovation by encouraging state collaboration; investing in telehealth, information technology (IT), and AI adoption; and helping small hospitals partner with larger systems. Dr. Oz urged states to use funds to license pharmacists to prescribe and dispense medications, helping to alleviate travel for patients.<\/p>\n

Dr. Oz also noted a nationwide nursing shortage, but that CMS has funding available to train nurses and is currently encouraging state-level matching and partnerships with local colleges to retain local nurses in their communities.<\/p>\n

Pharmacy Benefit Manager Reform<\/h3>\n

Dr. Oz acknowledged that pharmacy benefit manager (PBM) reform is important, though he stated the impact of such reform varies across the different components of the healthcare system. He also noted that PBMs have begun to compromise, particularly through rebate reforms and greater pricing transparency. Dr. Oz highlighted the introduction of TrumpRx, a new price transparency marketplace that helps consumers find the lowest available price for prescriptions, increases visibility, and empowers patients with options. He further suggested that effective reform can align PBM incentives with affordability and patient value.<\/p>\n

[1]<\/a> https:\/\/www.hhs.gov\/press-room\/kennedy-oz-cms-secure-healthcare-industry-pledge-to-fix-prior-authorization-system.html<\/a><\/p>\n

[2]<\/a> https:\/\/www.cms.gov\/newsroom\/press-releases\/hhs-announces-15-additional-drugs-selected-medicare-drug-price-negotiations-continued-effort-lower<\/a><\/p>\n

[3]<\/a> https:\/\/www.whitehouse.gov\/fact-sheets\/2025\/09\/fact-sheet-president-donald-j-trump-announces-first-deal-to-bring-most-favored-nation-pricing-to-american-patients\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

On October 6, 2025, The Health, Medicine & Society Program of the Aspen Institute hosted Public Health Grand Rounds with Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (CMS). Following initial remarks, Dr. Oz was interviewed by Bertha Coombs, CNBC Senior Health Care Reporter, to discuss the direction of the agency […]<\/p>\n","protected":false},"author":19,"featured_media":10095,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","ap4_related_services":"","footnotes":""},"categories":[433],"tags":[],"class_list":["post-10195","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-navigating-cms-rules"],"yoast_head":"\nDr. Oz Outlines CMS Priorities at Aspen Institute Event - Applied Policy<\/title>\n<meta name=\"description\" content=\"CMS Administrator Dr. Mehmet Oz addressed attendees at the Aspen Institute's Public Health Ground Rounds in October.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.appliedpolicy.com\/dr-oz-outlines-cms-priorities-at-aspen-institute-event\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dr. Oz Outlines CMS Priorities at Aspen Institute Event - 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