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Health Policy and Payment Update |
Key takeaways: |
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White House Releases FY27 Budget Request
What this means for you: The White House is again requesting that Congress cut NIH funding, but there has been consistent bipartisan support in Congress for robust NIH funding. AUGS will continue to track the appropriations process for FY 2027 as it amps up on Capitol Hill over the next few months.
The annual White House budget request is a nonbinding outline of the administration's funding goals for the coming year, and Congress can choose to adopt or reject the requests. The budget request kick starts the annual appropriations process, and congressional committees are assessing agency funding levels for FY 2027. The President's budget requests $41.2 billion for the NIH in FY 2027, a decrease from the $47.2 billion that Congress provided in FY 2026.
The budget requests additional policies and proposals that Congress has previously rejected. For example, the budget proposes a restructuring of the NIH to consolidate or eliminate some institutes. This year's restructuring proposal is not as large as what was in the FY 2026 budget proposal, which had proposed to restructure the NIH from 27 institutes into eight institutes, which Congress rejected. Of note, the FY 2027 budget proposal does not propose a consolidation of NICHD, NIDDK, or NIA. The budget requests that Congress enact a 15% cap on indirect cost rates, which had been previously pursued by the Administration but has been subject to ongoing litigation along with bipartisan congressional scrutiny. The budget also proposes to fully-fund upfront all research project grants in 2027 (also known as multi-year funding). In the FY 2026 appropriations bill, Congress implemented a cap on multi-year funding. |
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What this means for you: Having AUGS members share their first-hand experience and perspectives with congressional offices is invaluable in our advocacy efforts to ensure robust NIH funding and investments in women's health across the lifespan. Consider volunteering for future opportunities with AUGS to share your stories with policymakers.
During National Women's Health Week, on May 14, several AUGS members met virtually with five congressional offices. We spoke to Capitol Hill staffers about AUGS, the burden of PFDs on society, and the need for investment in women's health research across the lifespan and investment in junior scientists. In advance of our Hill Day, a bipartisan group of Senators introduced the Advancing Menopause Care and Mid-Life Women's Health Act, which would increase federal research, workforce training, and education efforts related to menopause. Among other provisions, the legislation would direct NIH to coordinate and expand federal research programs to study symptoms of menopause and treatments for those symptoms. AUGS was successful in getting PFDs added to the list of menopause symptoms in a draft version of the bill.
In line with this work, AUGS sent requests to seven Senate offices asking that they ensure increases to FY 2027 funding for the NIH, including NICHD. We also requested that they include language in the appropriations bill to invest in research across the female lifespan and support the women's health research workforce. |
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ORWH Hosts Pelvic Organ Prolapse Roundtable
What this means for you: Consider signing up for the roundtable to continue AUGS productive engagement with ORWH.
The event, on May 21 from 3:00 - 4:00pm ET, is part of a roundtable lecture series focusing on a range of issues affecting women's health. The May event will focus specifically on pelvic organ prolapse and feature two talks: Cellular Mechanisms in the Vagina of Women with Recurrent Vaginal Prolapse after Prolapse Surgery, and Pelvic Organ Prolapse: Pelvic Floor Disorders Network Trials and Future Research Directions. Speakers include members of the AUGS community; Dr. Bertha Chen and Dr. Heidi Harvie.
In late March, AUGS members met with ORWH leadership, including ORWH Director Clayton, to share our priorities and learn how AUGS can be supportive of ORWH efforts. NIH and ORWH has hosted multiple events recently aligned with AUGS priorities, including a three-day workshop focused on improving health during the menopausal transition. |
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Medicare Contractors Seek Comments on Botox Coverage Policies
What this means for you: Several Medicare Administrative Contractors (MACs) are considering updates to their coverage policies for botulinum toxin injections (Botox), including coverage criteria that could affect how urogynecologists treat patients with overactive bladder. AUGS is sharing these proposed policies (below) to ensure members are aware of potential changes under consideration. Because public comments can inform how MACs evaluate the evidence and finalize coverage criteria, members may wish to consider providing feedback on how the proposals align with current clinical practice and patient care needs.
MACs have released proposed Local Coverage Determinations (LCDs) addressing coverage for Botox, with public comment periods currently underway. LCDs are Medicare coverage policies issued by regional contractors that determine whether Medicare will cover a particular service within that contractor's jurisdiction. These policies often include specific requirements related to covered indications, patient eligibility, documentation, prior treatment, and medical necessity.
For urogynecologists, the proposed LCDs are particularly important because they address coverage criteria for Botox for conditions such as overactive bladder. Depending on how the final policies are written, they could affect when Botox is available to Medicare patients, what prior therapies must be attempted first, what dose ranges are recognized, and what documentation is required to support coverage.
AUGS is sharing this information so members are aware of the proposed LCDs and the opportunity to provide feedback during the public comment period. Members who choose to submit comments may wish to focus on the indications and coverage criteria most relevant to urogynecologic care, including prior therapy requirements, dosing flexibility, documentation expectations, and practical considerations for patients and clinicians. Feedback from clinicians can help MACs better understand how proposed coverage requirements may affect patient access and real-world care delivery before the policies are finalized.
Proposed Botox LCDs are currently open for comment from the following MACs: |
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Members who wish to submit comments should do so directly to the MAC that covers their jurisdiction. To support members who choose to comment, AUGS has prepared a call to action letter that may be used or adapted.
AUGS, in partnership with SUFU and SGS, has also submitted comments to each of the MACs. |
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NIH Director Bhattacharya Testifies about Early-Career Scientists, Multi-Year Funding
What this means for you: The testimony demonstrates priority areas for NIH, including multi-year funding, reproducibility, accountability, and early-career scientists.
During the hearing, Director Bhattacharya highlighted the new NIH Unified Funding Strategy as a means to reduce variability in funding practices, increase accountability and reproducibility, and better support for innovative and high-impact research, including projects led by early-career scientists. Democrats voiced concerns with the decline in NIH-approved grants and political interference in grant making decisions. Dr. Bhattacharya noted that NIH was in the process of accelerating grant approvals, specifically within NCI. Some Republicans on the committee spoke in support of capping indirect costs.
There was bipartisan concern from committee members about the declining support and opportunities for early-career scientists, and Democrats noted that multi-year funding arrangements and reduced overall award numbers have lowered success rates and discouraged young researchers from entering or remaining in the field. Director Bhattacharya acknowledged these challenges and stated that while multi-year funding can be justified to help early-career scientists build their labs, NIH will follow congressional limitations on its use, as passed in the FY2026 appropriations bill. He emphasized that supporting early-career investigators requires both policy changes and a cultural shift within NIH to encourage risk-taking on innovative ideas from new scientists, and signaled openness to expanding funding mechanisms that prioritize supporting promising researchers earlier in their careers. |
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