The healthcare ecosystem is shifting fast as new policies and market forces take hold. For commercial leaders and L&D executives, the second half of 2025 will bring both challenges and opportunities. To help your team prepare, CMR Institute has identified four key issues to watch and strategies to strengthen your value proposition in the months ahead.
1. Medicaid Funding Changes
The One Big Beautiful Bill Act (OBBBA) introduces sweeping Medicaid cuts and new eligibility requirements. With more patients at risk of losing coverage, providers and payers are facing increasing pressure. Commercial teams must be ready to demonstrate value, support physicians, and provide resources that ease the burden on care delivery.
2. Budget Reconciliation & Orphan Drugs
The Orphan Cures Act expands exemptions for rare disease drugs from Medicare price negotiations. While this supports innovation and treatment access, it also raises questions about costs for payers and patients. Teams should prepare to articulate product value with data-driven insights.
3. Spread Pricing Reform
Pharmacy benefit manager (PBM) practices, especially spread pricing, are under growing scrutiny. Although federal reform was dropped from the final bill, states are moving ahead with new rules. Greater pricing transparency could change payer and provider expectations, necessitating commercial teams to adjust their messaging.
4. Prior Authorization Reform
Pressure is mounting to streamline prior authorization (PA). With 91% of providers reporting delays that affect patient care, reform could improve access and reduce administrative burden. Teams can support customers by sharing clear guidance, reimbursement resources, and patient assistance information.
Why It Matters
Each of these issues has direct implications for how your team engages with providers, payers, and patients. Staying informed and equipping your team with the right training will help you build trust, strengthen relationships, and demonstrate value in a changing market.
For a deeper dive into these four issues and actionable strategies your team can apply right now, download the full CMR Institute white paper.
