Healthcare Brew covers pharmaceutical developments, health startups, the latest tech, and how it impacts hospitals and providers to keep administrators and providers informed.

Healthcare Brew

Maia Anderson

Healthcare Brew delivers the latest news and trends in healthcare.

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Hospital operating margins up slightly in November 2022

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Healthcare Economics

Cassie McGrath

It’s no secret US drug prices are much higher than the rest of the world—nearly 2.8x higher for branded and generics in 2022, in fact, the Department of Health and Human Services 

 about the cost of drugs in the US, and health research organization 

 over half of adults in the country are “very worried” or “somewhat worried” about affording their prescription medications.

Both public and private solutions have come forward to address these expenses, including the $35 insulin cap established in the Inflation Reduction Act or drug discount companies creating initiatives like 

 and direct-to-consumer (DTC) options like billionaire Mark Cuban’s 

On Sept. 30, the Trump administration announced a new public-private program to lower drug costs. Called TrumpRx, the partnership with pharma giant Pfizer intends to sell drugs directly to patients at prices 40%–85% cheaper than usual and doesn’t go through insurance, according to press releases.

The administration said patients can navigate to TrumpRx.gov starting in 2026 and find price discounts for drugs from Pfizer, including topical ointment Eucrisa, arthritis medication Xeljanz, and migraine treatment Zavzpret.

While the program started with Pfizer—boosting its 

 after the announcement and helping the company potentially 

 for three years—the administration said it plans to expand its partnerships. As of Oct. 10, it has already started that process, announcing a partnership with AstraZeneca that offers discounts ranging from 96% to 654% off the undefined “deal price” of three respiratory drugs. Exact prices are still private, however.

“Anything that makes drugs—particularly new drugs—more accessible to consumers is a positive,” Gary Zammit, president and CEO of contract research organization Clinilabs, told Healthcare Brew. “What is yet to be seen is whether or not other pharmaceutical companies will come on board and to what extent the benefits of TrumpRx will be extended to the general population.”

Programs to lower drug prices are not new. In fact, the Trump administration and Pfizer’s DTC partnership is similar to the Cost Plus Drugs model, where patients purchase medication directly from drugmakers, avoiding pharmacy benefit managers (PBMs) and providing options for people without insurance.

, and these DTC programs like TrumpRx and Cost Plus Drug intentionally avoid the intermediary.

Cost Plus Drugs is mostly for generics, however, whereas the Trump administration is taking a company-by-company approach to expand into branded drug discounts.

Cost Plus didn’t respond to a request for comment, though its founder, Cuban, wrote in 

 the same day as the announcement that the initiative “will be amazing” for Cost Plus’s business since its “overhead and markups are lower than everyone else.”

But Rajiv Leventhal, senior analyst in digital health at research firm eMarketer, told us there isn’t a big difference between TrumpRx and what already exists on the market.

Big pharmaceutical companies already have DTC sites, 

 by Eli Lilly, Pfizer for All, and NovoCare through Novo Nordisk. These sites also offer discounts: For example, customers can get 50% off Lilly’s popular weight loss medication Zepbound through Lilly Direct.

Around the time of the program announcement, more companies (including Amgen and AstraZeneca) launched their own DTC websites to sell medications, potentially opening the door for them to distribute drugs through TrumpRx in the future, Leventhal said.

Still, “there’s really no difference here,” Leventhal said, except TrumpRx is creating one central marketplace to make it easier for patients to find the DTC offerings.

“It’s not going to affect most people, and that’s because the drugs are still going to be very high [in price],” he said, adding that most people get their medications through insurance and typically only pay out of pocket if they have a high deductible or the drug isn’t covered by their plan.

Zavzpret, for example, can cost over $1,000 out of pocket for six doses, according to Leventhal and drug price comparison company SingleCare. Even if the medication is discounted 50%, $500 would still be out of reach for most people, he said.

“There’s probably a small subset of patients that maybe can save some money through these offerings, but I would say it’s a very small subset,” Leventhal said.

What’s TrumpRx, and how does it compare to other DTC options?  

Experts say it’s not so different from existing choices, like drug discount company Cost Plus Drugs.

illustrated headshot of caroline catherman, healthcare brew reporter

Caroline Catherman

As people across the country consider their 2026 health insurance options, there’s a massive elephant in the room: Some aren’t thrilled with the industry right now.

, global research and advisory firm Forrester found only 54% of 12,036 insurance customers describe health insurers as trustworthy.

 of consumers were satisfied with their coverage, that is the past.

Forrester found waning trust may impact business. Survey results included in the report show that of 7,512 customers, those with less trust in their insurer were 10.3x more likely to switch insurers compared to high-trust customers, up from 2.4x more likely in 2024.

“As consumer choices expand, including not buying health insurance, the risk of churn becomes more pronounced,” Forrester Principal Analyst Arielle Trzcinski told Healthcare Brew.

Over the last few years, allegations of health insurers’ wrongdoings have come to the forefront, Katherine Hempstead, senior policy advisor for nonprofit the Robert Wood Johnson Foundation, told us.

 that found UnitedHealthcare had pressured clinicians to follow algorithms that cut off certain patient care. 

“That kind of reporting has left a really bad taste in peoples’ mouths and confirmed a lot of suspicions,” Hempstead said. “[Insurers] have to do a lot of work to undo that damage.”

Since then, many health insurers have talked the talk in an effort to bridge the divide. In June, UnitedHealth and other major health insurers 

, which 93% of physicians say delays patient care, according to a 2024 American Medical Association survey.

, however, found 6 in 10 adults feel it’s “not too likely” or “not at all likely” health insurance companies will follow through.

Trzcinski said she’s talked to some insurers who are walking the walk, too.

Other survey results in the report show that, of 562 adults, only 53% felt they understood claim decisions. Trzcinski said Forrester client 

 is an example of a company “overhauling” the explanation of benefits to include more straightforward language.

Trzcinski also pointed to Blue Shield of California, which has committed to answering “at least 80% of prior authorization requests in near real time” in 2027. Prior authorization “typically” takes 24 to 72 hours, according to a page on the insurer’s website last updated in October. (Specific data on this is not required to be published and thus hard to track.)

“Health insurers must put in the hard work to repair trust and their brand image. Rebuilding trust and improving brand experience is much more than just a marketing campaign or a messaging problem,” Trzcinski said.

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Trust in health insurers ‘nearing the point of no return,’ survey finds

You can’t trust anyone these days, apparently.

Welcome back to Signed and Scrubbed, a monthly roundup of hospital deals, developments, and bankruptcies.

We pulled together a list of provider transactions from September, including transactions from TriHealth in Cincinnati, Ohio and Hartford HealthCare in Hartford, Connecticut. Here’s the rundown.

Lebanon, New Hampshire-based Dartmouth Health signed a letter of intent on Sept. 12 to acquire 25-bed critical access center Littleton Regional Healthcare, also in New Hampshire.

Hartford HealthCare signed an agreement to acquire 249-bed Manchester Memorial Hospital and 102-bed Rockville General Hospital for $86 million from real estate investment trust Prospect Medical Properties, which is in bankruptcy proceedings, 

 On Sept. 2, Scottsdale, Arizona-based HonorHealth signed an agreement to acquire Evernorth Care Group, which has 20 care centers around the state. If the health system obtains the necessary regulatory and legal approvals, the deal is expected to close in early 2026.

Tallahassee locals Florida State University and Tallahassee Memorial HealthCare signed an agreement on Sept. 16 to turn the hospital into an academic medical center, a plan underway for a decade, according to a release.

 Cincinnati, Ohio-based TriHealth acquired its sixth acute hospital on Sept. 2: 140-bed Clinton Memorial Hospital based in Wilmington, Ohio.

Farmington, Connecticut-based UConn Health is in talks to acquire three other Connecticut hospitals: 154-bed Bristol Hospital, 104-bed Day Kimball Hospital, and 357-bed Waterbury Hospital for $400 million, according to the 

Hospital building split in half collaged with briefcase and $100 bill. Credit: Illustration: Anna Kim, Photos: Adobe Stock.

Signed and Scrubbed: September 2025 hospital M&A

TriHealth, Hartford HealthCare, and UConn Health announced M&A this month. 

 that it had opened two new national security investigations, also known as Section 232 investigations, into personal protective equipment (PPE) and medical items as well as robotics and industrial machinery imports.

These investigations are a signal of possible tariffs on these products, as they ask companies to report how devices and their parts can, among other things, “meet domestic demand.” The probe began on Sept. 2 but wasn’t reported publicly until last week.

 in a Truth Social post 100% tariffs would be coming for certain imported drugs unless parent companies have started building a facility on US soil by Oct. 1. That’s 

 around whether pharmaceutical tariffs were coming and what they would look like. (In August, President Donald Trump 

As of publication, there are no specific tariffs on medtech or pharmaceuticals, though there 

 on goods from China and 20.8% for the rest of the world. Professional supply chain organization the Association for Health Care Resource and Materials Management reported these tariffs could increase hospital expenses “by at least 15%.”

“At the end of the day, tariffs are essentially a tax on fragility. Without smart exemptions and faster investment in domestic capacity, we risk raising today’s prices without actually protecting tomorrow’s supply,” Pankit Bhalodia, partner at consultancy West Monroe, told us in an emailed statement.

Mergers and acquisitions (M&A) in the medtech industry have been down so far this year, 

, which found there were 104 transactions in Q2 2025, compared to 128 in Q2 the year prior.

Managing director at PMCF Bryan Hughes told Healthcare Brew this can be connected to tariff-related market “uncertainty.”

“The tariffs have obviously been all over the place, and what we’ve seen is it’s really paused a lot of discussions around potential M&A activity, as well as other investments,” he said.

While Hughes said he’s watching to see how the Section 232 affects the market, he thinks activity will still remain slow amid the uncertainty. Otherwise, he’s keeping an eye on products like gloves, masks, and gauze, which are 

“I don’t think anyone knows what’s going to happen with tariffs,” he said, but there’s “much less room to absorb some of that cost pressure” from PPE used every day compared to medical devices.

These incoming pharmaceutical tariffs could impact $229 billion in drug imports to the US, the 

Big biotech companies like Johnson & Johnson, Eli Lilly, and GSK are dealing with tariffs by announcing new investments in US manufacturing facilities. Pfizer also 

 with the Trump administration on Sept. 30 to offer discounted drugs in exchange for waived tariffs for three years, so long as the pharma company continues to manufacture in the US.

But Bhalodia said reshoring a facility is a long process. Getting FDA validation for a new drug facility can be “multiyear efforts,” and the benefits “won’t be immediate,” he said.

Bhalodia expects prices for branded medicines will be impacted by tariffs but not as much as generic drugs, which he said will be hit harder. He predicts more market consolidation and M&A as a result.

“Any incremental tariff [for generics] could have a very immediate effect. There’s not enough margin to absorb that kind of shock,” he said.

Otherwise, Bhalodia said he thinks tariffs will drive technology adoption due to the “labor premium” from onshoring.

But, he added, pharmaceuticals “cannot afford to sit back.”

“They should be mapping where tariffs will hit, pressing suppliers to share in the cost burden, building 60 to 90 days of safety stock, and filing for exemptions where possible,” he said.

Cargo container hitting large-scale medical cross symbol.

Medtech, pharma tariffs loom over healthcare industry 

The healthcare industry should start preparing for tariffs, expert says.

More and more, the lines between for-profit and nonprofit hospitals are blurring.

Sometimes a nonprofit is an independent rural hospital and sometimes it’s part of an academic medical center, with billions of dollars in 

 that launch devices and drugs using their own staff. For-profits, on the other hand, operate just like other traditional companies outside of healthcare. 

While nonprofits don’t answer to shareholders,

they may not be that different from their money-making counterparts these days.

So what truly distinguishes for-profit and nonprofit care?

, there are 6,093 hospitals in the US, 2,978 of which are nonprofits and 1,214 for-profits. The biggest difference—don’t yawn—is probably the paperwork.

For-profits, like in any industry, can be either privately or publicly owned. Systems like Nashville-based HCA Healthcare; Dallas-based Tenet Healthcare; Franklin, Tennessee-based Community Health Systems; and King of Prussia, Pennsylvania-based Universal Health Services are all publicly traded. That means they have the same rules and paperwork of typical public companies, like SEC disclosures, earnings reports, and shareholder meetings.

Other systems are privately owned and operated, like Brentwood, Tennessee-based Lifepoint Health, owned by private equity firm Apollo Global Management, or the 

. These hospitals are treated more like traditional private companies run by their owners.

“On the for-profit side, it’s about maximizing shareholder value, being profitable, and getting return on investment,” Rahul Singh, leader of consultant company West Monroe’s healthcare provider practice, told us.

From a “pure care delivery perspective,” he added, there’s more focus on markets and procedures that return the most value to investors.

Recent research from the University of Pennsylvania 

 due to cost cutting was tied to worse patient outcomes at for-profit hospitals. The Association of American Medical Colleges 

 last year that nonprofits were more likely to offer unprofitable services, like psychiatrics.

“That’s what a for-profit company does, regardless of whether it’s in healthcare or not,” he said.

When you think of nonprofit health systems, Chicago-based CommonSpirit Health, Oakland-based Kaiser Permanente, St. Louis-based Ascension, and Oak Brook, Illinois-based Advocate Health Care likely come to mind. There are also systems connected to universities, like Northwestern Medicine in Chicago, Cedars-Sinai in Los Angeles, and NewYork-Presbyterian.

These systems are meant to be mission-driven and are, therefore, tax exempt. To achieve this status, they must meet the IRS’s Community Benefit Standard reporting requirements, proving they benefit their local communities, don’t enhance the wealth of individuals or shareholders, and don’t intervene in political campaigns. (Though 

 that the definition of “community benefits” is broad, and a clearer definition may be helpful.)

Under this tax structure, they can also raise funding through bonds, which is a common way to pursue new projects outside of operational revenue or philanthropic donations.

These organizations are “more focused on making sure that everyone has access to healthcare, as opposed to trying to maximize profit from healthcare,” Singh said.

Industry experts, however, have begun questioning if nonprofits always act like charities. Health policy research organization KFF, for example, 

 last year that some nonprofit systems own for-profit hospitals in other countries or operate for-profit insurance companies.

Others, like Northwell Health, also have a 

 that in 2022 most nonprofits generally had enough cash on hand and that only 9% of the 274 hospitals and health systems surveyed were in a financially “vulnerable” or “highly vulnerable” state.

But those patients still need care. Singh said other areas of revenue, like venture arms, are one method to continue providing care to patients in underserved communities. “That’s one way for [nonprofit hospitals] to survive,” he added.

Hand hold golden coin above the hospital building,  doctor, nurse, patients, helicopter and ambulance car in flat style. Hospital building, doctors, nurses, woman in wheelchair. Investment concept.

What’s the difference between for-profit and nonprofit hospitals? 

It may sound simple, but as nonprofit hospitals launch venture arms, the lines become increasingly blurred. 

What’s the difference between for-profit and nonprofit hospitals?

CVS subsidiary Omnicare, which provides pharmacy services to long-term care facilities, filed for Chapter 11 bankruptcy protection on Sept. 22. The move comes a couple months after a judge 

 Omnicare to pay roughly $949 million in penalties for allegedly overcharging Medicare, Medicaid, and Tricare (the federal insurer for the military) for prescription drugs.

It also comes a few months after pharmacy chain Rite Aid 

 its second Chapter 11 bankruptcy petition.

David Azzolina, Omnicare’s president, said in a press release announcing the bankruptcy filing that the penalty was “extreme” and potentially “unconstitutional.”

“Omnicare has been engaged in a civil lawsuit alleging technical violations of pharmacy law based on practices the government knew about and approved,” Azzolina said. “There were no allegations of harm to any Omnicare patients nor did the government allege that any patient got anything other than the medicine they needed when they needed it.”

Rohan Kulkarni, executive research leader for business consultancy HFS Research, told Healthcare Brew Omnicare’s bankruptcy filing didn’t come as a surprise given the size of the penalties the company was ordered to pay.

The bankruptcy likely won’t do much financial damage to CVS, Kulkarni said, as Omnicare makes up only a small portion of the overall company. CVS doesn’t report financial results for Omnicare separately from its other subsidiaries, so the exact percentage is unclear, but based on the market’s reactions to both the lawsuit judgement and the bankruptcy news, Kulkarni estimated Omnicare makes up 3% to 4% of CVS’s total business.

After the judgement was announced, the stock dipped less than 1%, and after the bankruptcy news, the stock increased by about 1%.

However, the move could result in some reputational damage for the company, Kulkarni added.

“Over a period of time, CVS’s decision-making [and] CVS’s performance have indicated that they’re probably not really good at managing and operating a vertically integrated healthcare enterprise,” he said. “We’ve seen their 

. We’ve seen their challenges with some of their 

And while CVS executives said in the press release they’re considering selling Omnicare, Kulkarni said they’ll likely only do so when “the dust is settled” since the company’s value would be too low immediately following the bankruptcy news.

Kulkarni also said he expects some layoffs at Omnicare, “or some form of business process reengineering, some leadership shown the door.”

, Omnicare listed assets of between $100 million to $500 million and liabilities of $1 billion to $10 billion.

Omnicare executives said in the release that the company has secured $110 million to fund its operations through the bankruptcy process.

“Omnicare remains fully focused on meeting the pharmacy needs of its customers and long-term care residents,” the release stated.

Slavin told Healthcare Brew the company has no additional comment beyond the press release.

Omnicare’s bankruptcy comes after a slew of changes to the retail pharmacy market, including competitor Walgreens 

 to private equity firm Sycamore Partners in August.

 in the last couple of years amid changing consumer habits, increased competition from 

A CVS pharmacy stands in a Brooklyn neighborhood in New York City.

What Omnicare’s bankruptcy could mean for CVS 

The subsidiary filed for Chapter 11 protection after being ordered to pay nearly $1 billion in penalties for alleged overbilling. 

Nicole Ortiz

While the federal government has made clear that issues like 

 have been deprioritized, that hasn’t stopped some hospital leaders from continuing to pursue those goals.

In fact, according to the latest sustainability benchmark report from Health Care Without Harm and Practice Greenhealth, the opposite may be true. The health sustainability nonprofit’s annual report found that among almost 493 hospital partners, there’s been a reduction of roughly 185,000 metric tons of greenhouse gases and more than $203 million in annual savings due to sustainability initiatives.

, our partners are still deeply committed to their sustainability strategies,” Sarah Irwin, associate director of sustainability solutions at Practice Greenhealth, told us. “Some of our partners might be doing that in slightly different ways than they did before…but the work is still happening—and in fact, they’re doubling down.”

For Washington-based nonprofit Providence Health, Beth Schenk, chief environmental stewardship officer, told us the health system is approaching sustainability through mitigation, procurement, resilience, and advocacy.

“[We’re] working to address the problems that we can to help move healthcare to a way of operating that’s more compatible with a healthy planet,” she said.

Providence’s 51 hospitals and 1,014 clinics adhere to its WE ACT framework, which focuses on creating sustainable initiatives around waste, energy and water, agriculture and food, chemicals, and transportation. Each facility has been rated on a scorecard annually since 2019 based on data collected from 150+ categories tied to the five themes in the framework.

In 2020, the environmental stewardship team set a goal of becoming more carbon negative by 2030 and cutting between 3%–5% of emissions per facility each year, reaching a 23% cut in its hospitals so far. Schenk confirmed the health system is on track to achieve both goals. This has resulted in $32 million in savings associated with the stewardship programs for 2024 and $40 million for 2023, she added.

Having “accurate, transparent, verifiable data in order to justify and defend different requests for expensive finances, how are we going to measure our progress, etc.” was an important part of committing to these goals, she said.

, Providence has reduced Scopes 1, 2, and 3 carbon emissions—which include emissions an organization directly and indirectly emits—by 18% since 2019 and has saved $15 million annually in conservation efforts. For reference, a 

 of multiple databases found healthcare made up between 15% and 50% of Scopes 1 and 2 emissions and 50% to 75% of Scope 3 emissions—that accounts for between 4% and 5% of all greenhouse gas emissions worldwide.

This also aligns with what Practice Greenhealth found: Among its partners that reported 2024 Scope 1 and 2 emissions, there was an 8.7% decrease overall.

Providence’s post goes on to state that 100 of its facilities run fully on renewable energy and 85% of its hospitals have deactivated “wasteful” nitrous oxide piping. Further, business travel has operated at a 50% reduction since 2019, according to the post.

Reducing plastic use features heavily in the Greenhealth study, too, with almost 50% of its partners saying they’ve made efforts to reduce plastic use in their facilities.

The Ohio State University Wexner Medical Center, for example, has a partnership with medical reprocessing manufacturer Stryker’s Sustainability Solutions, which reprocesses devices like cables, catheters, and pulse oximeters, saving $1.4 million between July 2023 to July 2024.

According to Ohio State’s Environmental Sustainability Consultant Cecil Okotah, since the program was implemented in 2021, the university has saved close to $4 million and been able to divert almost 60 tons of waste from landfills between 2018 and 2024.

Practice Greenhealth estimated 20%–25% of hospital waste is plastics in 2024, but less than 5% is actually recycled, according to a 

The university also has sustainability initiatives to decrease energy use in its facilities, increase composting and recycling efforts, and implement 

For Practice Greenhealth, the more data it can get from hospital partners the better, as that can serve as a roadmap for other institutions. Especially since partners can be at any stage, from “extremely new” to “fairly mature,” Irwin said.

Hospitals that are newer to sustainability initiatives then get the opportunity to learn from veteran teams and see how they can implement what’s already proven to be effective, she said.

As for one of the areas that needs the most continued attention? Irwin said transportation is where she thinks there’s “more that we can be doing and supporting” since it’s so far-reaching—encompassing everything from daily commutes to the Scope 3 emissions from materials being flown or driven to a facility—and the data tends to come from third-party resources.

For Schenk, moving into a place where more institutions take sustainability “seriously” is an integral next step in implementing industrywide change.

“We’re here for health,” she said. “I think in healthcare we have even more of an obligation to not to cause harm and also to be ready and planning and responding to the harm that is underway.”

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Healthcare Economics

What’s TrumpRx, and how does it compare to other DTC options?

Trust in health insurers ‘nearing the point of no return,’ survey finds

Signed and Scrubbed: September 2025 hospital M&A

Medtech, pharma tariffs loom over healthcare industry

What’s the difference between for-profit and nonprofit hospitals?

What Omnicare’s bankruptcy could mean for CVS

Trend report suggests sustainability is still important to hospital leaders

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