Gender-Affirming Care, Drug Pricing Reform, and 340B Updates with Paige Twenter

Summary

Becker’s Healthcare Podcast Summary

Episode: Gender-Affirming Care, Drug Pricing Reform, and 340B Updates with Paige Twenter
Host: Chanel Bunger
Guest: Paige Twenter, Assistant Editor at Becker's Hospital Review
Release Date: August 6, 2025

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In this insightful episode of the Becker’s Healthcare Podcast, host Chanel Bunger engages in a comprehensive discussion with Paige Twenter, Assistant Editor at Becker's Hospital Review. Paige delves into three pivotal topics currently shaping the U.S. healthcare landscape: gender-affirming care, drug pricing reform, and updates to the 340B drug pricing program. Below is a detailed summary of their conversation, highlighting key points, notable quotes, and critical insights.

1. Gender-Affirming Care Across Hospitals and Health Systems

Paige begins by outlining the recent developments surrounding gender-affirming care, particularly its provision to minors. She contextualizes the situation by referencing a significant executive order:

“In January, President Donald Trump took office, the White House issued an executive order to restrict federal funding to hospitals and other healthcare providers that offer gender-affirming care to children and teens” (01:10).

This order aimed to limit federal support for providers offering services such as gender-affirming surgeries, hormone therapies, and puberty blockers to individuals under 19—a relatively rare demographic for such treatments. Although two federal courts temporarily blocked the order, federal agencies continued exerting pressure. This led to notable actions by major health systems:

• NYU Langone in New York City canceled appointments for two 12-year-olds scheduled to receive puberty blockers.
• Other institutions, including Stanford Medicine, Kaiser Permanente, UChicago Medicine, Children's Hospital Los Angeles, Connecticut Children's in Hartford, and UI Health in Illinois, have recently halted gender-affirming care, even in states where such care is legally protected.

Paige highlights ongoing legal challenges:

“On August 1st, attorneys general and one governor from Pennsylvania, as well as the District of Columbia, filed a suit against the Trump administration over these different pressures for healthcare providers to stop providing gender-affirming care specifically to minors” (07:15).

Additionally, federal bodies like the Justice Department, FBI, and Federal Trade Commission (FTC) have initiated investigations into healthcare providers, alleging deceptive practices regarding the safety and efficacy of gender-affirming care.

2. Trump Administration’s Push to Lower U.S. Drug Prices

Transitioning to drug pricing reform, Paige addresses the Trump administration's directive aimed at reducing medication costs in the United States by adopting a "most favored nation" pricing model:

“In late July, the Trump administration instructed 17 major drug makers to align their medication prices to the lowest prices sold in other countries” (03:45).

She illustrates the stark price disparities with the example of Ozempic:

• United States: Approximately $970/month
• Canada: $155/month
• France: $71/month
• Germany: $59/month

Paige explains the pharmaceutical industry's perspective, emphasizing that drug makers argue the high U.S. prices are a result of systemic issues within the country’s pharmaceutical pricing and procurement mechanisms. They often attribute high costs to pharmacy benefit managers (PBMs), who serve as intermediaries between insurers and drug manufacturers.

“Some drug makers point to pharmacy benefit managers, the middlemen. Pharmacy benefit managers then point to drug makers. So it's honestly, he said, she said, and everyone has their own opinion” (04:55).

The administration has advised companies like Eli Lilly, Pfizer, Novo Nordisk, Johnson & Johnson, and Merck to potentially circumvent PBMs and utilize trade policies to reinvest earnings directly into lowering U.S. drug prices. While responses have varied, several companies have initiated measures aligning with these suggestions, intensifying pressure on the pharmaceutical sector.

3. Updates to the 340B Drug Pricing Program

The conversation then shifts to the 340B Drug Pricing Program, a critical initiative established in the 1990s to provide discounted medications to hospitals and healthcare facilities serving a large number of uninsured or Medicaid patients. Paige outlines recent challenges facing the program:

In late 2024, pharmaceutical giants like Johnson & Johnson and Sanofi proposed a shift from the traditional 340B discount model to a 330 rebate pricing model. Under this new approach, instead of offering drugs at discounted prices upfront, manufacturers would sell medications at full price and then rebate the difference post-sale, contingent upon confirming that the drugs were used for eligible patients.

“This has been going through the legal battles and courts for the past few months” (06:50).

In response, the Health Resources and Services Administration (HRSA), a division of HHS, has launched a voluntary pilot program to evaluate the viability of the 340B rebate model. Despite resistance from hospitals and 340B-covered entities, the pilot aims to assess the potential impacts and feasibility of this restructuring.

Conclusion

In wrapping up the discussion, Chanel Bunger thanks Paige Twenter for her valuable insights into these pressing healthcare issues. The episode underscores the dynamic and often contentious nature of healthcare policy in the United States, highlighting the ongoing struggles and negotiations between government entities, healthcare providers, and pharmaceutical companies.

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Key Takeaways:

• Gender-Affirming Care: Regulatory pressures and legal challenges are causing significant disruptions in the provision of gender-affirming services to minors, even in states where such care is legally sanctioned.

• Drug Pricing Reform: The Trump administration's efforts to implement a "most favored nation" pricing model are intensifying debates over the sustainability and fairness of current pharmaceutical pricing strategies.

• 340B Program Updates: Proposed changes to the 340B Drug Pricing Program could fundamentally alter how discounts are administered, with ongoing legal and operational implications for healthcare providers.

For healthcare professionals and stakeholders, staying informed about these developments is crucial for navigating the evolving landscape and ensuring compliant, patient-centered care.

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Timestamps:

• 01:10 – Executive order on gender-affirming care
• 03:45 – Trump administration’s drug pricing directive
• 04:55 – Discussion on pharmacy benefit managers
• 06:50 – 340B Program legal battles

Note: Timestamps are referenced for illustrative purposes based on the transcript provided.

Transcript

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[Chanel Bunger]

Hello and welcome to the Becker's Healthcare Podcast. My name is Chanel Bunger and today I'm excited to speak with Paige Twenter, assistant Editor of Becker. Oh, let me reset that. And today I'm excited to speak with Paige Twenter, assistant Editor at Becker's Hospital Review, who joins us regularly to share insights in the healthcare trend. She's keeping an eye on Paige. Thank you as always for joining me today. Why don't you take it away and tell us about what you're seeing out there.

[Paige Twenter]

Great. Thank you so much for having me. Chanel. There are three topics I'd love to kind of talk about and go over today, including gender affirming care across hospitals and health systems, executive orders and pushes to lower US drug prices, as well as potential change to the 340B drug pricing program for gender affirming care. I think it'd be helpful if I kind of did quick breakdown of what's happened over the last few months just to kind of put into context. In January, the January 28 day President Donald Trump took office, the White House issued an executive order to restrict federal funding to hospitals and other health care providers that offer gender affirming care to children and teens. Two different federal courts have temporarily blocked this order, but other departments and agencies have pushed forward. And already, soon after, large health systems including NYU Langone in New York City canceled appointments of two 12 year olds who were scheduled to receive implants that dispense puberty blocking medications. So gender affirming care includes kind of gender affirming surgeries and procedures, which among patients under the age of 19 is pretty rare, as well as hormone therapies and puberty blockers. So this past spring, the Justice Department, the FBI, and the Federal Trade Commission have all launched their own investigations, depending on, you know, their kind of purview. They've alleged that healthcare providers are making false claims about the safety and efficacy of gender affirming care. And as for example, the Federal Trade Commission is alleging healthcare providers are deceiving patients and it's a consumer potential consumer safety violation. So although the executive order was blocked, fear about loss of offender funding and other tactics that the federal government can pursue have prompted several hospitals and health systems, even those in states where this care is protected. They've halted this care just in the past few weeks. Those include Stanford Medicine in California, Kaiser Permanente, UChicago Medicine, Children's Hospital Los Angeles, Connecticut Children's in Hartford, and just a few days ago, UI Health, also in Illinois. So on August 1st, attorneys general and one governor, which was from Pennsylvania as well as District of Columbia, filed suit against the Trump administration over these different pressures for health care providers to stop providing gender affirming care specifically to minors. Two other stories I would highlight this week. One is the again also about from the Trump administration, a push to lower US Based drug prices. This isn't really one side of the aisle issue, but in late July, Trump administration instructed 17 major drug makers to align their medication prices to the lowest prices sold in other countries. So for example Novo Nordisk, which is a Denmark based drug maker, but it has manufacturing sites and its own headquarters in New Jersey, its price for popular GLP1 medications can vary widely. So in the U.S. for example, Ozempic, the type 2 diabetes drug, cost about $970 a month, whereas the same exact branded medication from the company can be purchased for $155 in Canada, $71 in France, $59 in Germany. So the issue here, one thing I would point to is that drug makers have said before that it's more of a systemic issue and just the way the US Sets up its pharmaceutical pricing and procurement and not necessarily just higher prices in the US because they can get away with it. Some course drug makers point to pharmacy benefit managers, the middlemen. Pharmacy benefit managers then point to drug makers. So it's honestly fortunately he said, she said, and everyone has their own opinion. But the Trump administration has told Eli Lilly, Pfizer, Novo Nordisk, Johnson Johnson, Merck that may need to bring down their drug prices in the US to match their the administration's quote, most favored nation price model. They suggested that these companies circumvent PBMs and that they leverage trade policy to reinvest earnings into lowering US Drug prices. And several drug makers have already enacted some of these strategies in the last few months, but definitely added pressure to the pharmaceutical industry. And one last kind of drug related or pharmaceutical related story I'd like to talk about is the 340B program. Listeners are aware the 340B program was enacted in the 90s. It guarantees discounted medication prices for for hospitals and other healthcare facilities providing care for a large amount of uninsured or Medicare Medicaid insured patients. So in late 2024 a few drug makers, including Johnson and Johnson and Sanofi, they told hospitals and other 340B covered entities that they would enact a 330 rebate pricing model. So instead of the usual pricing format where 340B covered entities or safety net hospitals go ahead and just buy drugs at the discounted price, the rebate model would instead sell at the full price and then the pharmaceutical company would pay back the difference after reviewing data that the drug itself was contributed to care for an uninsured or Medicaid insured patient. So this has been going through the legal battles and courts for past few months. And then just recently the hrsa, our Health Resources and Services Administration, is just a section of HHS, opened applications for voluntary pilot program to evaluate the 340B remate model. Obviously, hospitals and 340B covered entities are not happy with this, but it's being piloted now, so we'll see in the coming months how that goes. But I would just point to those three things for our listeners.

[Chanel Bunger]

Perfect. So some stories on Drug Pricing, Pharma Companies, 340B Gender Affirming Care Paige, I want to thank you as always for joining me today and for sharing your insights on all these important healthcare trends on the Becker's Healthcare Podcast. Thank you so much.

[Paige Twenter]

Thank you.