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Pfizer's decision to announce a deal with the Trump administration on drug prices yesterday caused an uproar within much of the pharmaceutical industry, most of which was caught off guard by the announcement.

Why it matters: Pfizer CEO Albert Bourla's acquiescence to President Trump's demands — broadcast live from the Oval Office as the two men stood side by side — puts much more pressure on other drug companies to fall in line after months of unified resistance to Trump's "most favored nation" pricing plan.

Driving the news: Pharmaceutical lobbyists said the agreement was more far-reaching than they expected and would put pressure on other companies to reach similar terms on international pricing parity and other issues.

• Pfizer agreed not to launch new drugs at higher prices in the U.S. than in other wealthy countries and will sell drugs to Medicaid at most-favored-nation prices. It will also offer discounted drugs on a direct-to-consumer TrumpRx website for people paying cash without insurance.
• President Trump said that he expects other companies to individually make deals in the coming weeks, naming Eli Lilly as one possible company.
• He raised the threat of additional tariffs on companies that do not come to the table.

Between the lines: "The interesting element to me is how many companies sort of knew something was going on but refused to allow themselves to believe a deal would get cut," said one source familiar with the negotiations between drug companies and the administration.

• "Many of them are questioning whether they need to be or should have been more aggressive in dealing with the administration. And by aggressive I mean aggressive in coming to a deal."
• Bourla is also the board chair of PhRMA, the industry's top trade group. The fact his company was first to cut a deal has put other member companies in an awkward position after PhRMA for months pushed back against Trump's plan.
• PhRMA CEO Steve Ubl noted in a statement that "each company makes its own decision" on pricing, but criticized the Pfizer pact for not "do[ing] enough to address the real drivers of higher prices in the U.S.," such as PBMs and hospital markups.
• He again warned most-favored-nation pricing would harm innovation.

The big picture: The drug industry still could stave off new pricing regulations if enough companies opt to cut deals with the White House.

• Pfizer's stock rose 6.8% yesterday, with other large drugmakers seeing similar increases. Bourla mentioned how the deal reduced uncertainty both about pricing and the possibility of tariffs.

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The government shutdown left some seniors without access to telehealth, while others receiving hospital-level care at home are being discharged or sent back to inpatient units.

The big picture: Congress only authorized Medicare to pay for expanded telehealth care and the Acute Care Hospital at Home initiative through yesterday — meaning additional legislation is required to restore the services.

• Most other Medicare and Medicaid services will continue as normal during the shutdown, and providers' insurance claims will still be paid out.
• "Real Americans will be worse off" without coverage of these services, said Kyle Zebley, senior vice president of public policy at the American Telemedicine Association.

Where it stands: All hospitals participating in the hospital-at-home initiative had to discharge patients or move them to physical hospitals yesterday after government funding lapsed without Congress renewing the program, per a recent notice from Medicare administrators.

• Several health systems like Mass General Brigham in Boston and Hackensack Meridian Health in New Jersey started phasing out their hospital-at-home patients early, in anticipation of a shutdown. That further strained already crowded inpatient facilities, Stat reported.

Providers can still offer telehealth services to all Medicare enrollees — they just won't get paid for it. Congress could authorize back pay for claims made during the shutdown if it chooses to extend the programs.

• Some health systems and Medicare group practices that belong to the American Telemedicine Association are cutting off seniors' telehealth access starting today, Zebley said.

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Premiums will more than double for millions of Affordable Care Act enrollees next year if Congress does not renew enhanced marketplace subsidies by year's end, according to a new analysis.

Why it matters: The tax credits that help people afford premiums are at the center of the showdown over government funding, and the latest findings underscore the stakes if they are not renewed, as Democrats insist they must be.

Driving the news: Average premiums would increase 114%, from $888 to $1,904 per year, the analysis from KFF finds.

• That is a considerable burden for the roughly 22 million ACA enrollees who receive subsidies.

The big picture: Congressional Democrats have made renewing the enhanced tax credits their key ask in the standoff over funding the government.

• GOP leaders won't rule out talks later this year on a limited extension, possibly with changes like cutting off the tax credits for people with higher incomes.
• But they say the current short-term funding bill is not the place to have the negotiation.
• Democrats are pressing for action now, noting signups for next year begin on Nov. 1, and that people facing sticker shock could drop coverage.

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Tell Congress: Protect Access to 24/7 Care — because when the doors close, it is too late.

More than 300 hospitals are now at risk of closure, threatening access to critical care. We’re here to heal, but we need your help to stay here.

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President Trump signed an order yesterday directing his administration to invest $50 million in AI-driven pediatric cancer research.

Why it matters: The move is part of a broader embrace of artificial intelligence across federal agencies but comes as the administration is slashing biomedical research spending and pausing grants.

Driving the news: The order directs the presidentially appointed Make America Healthy Again Commission to work with the Office of Science and Technology Policy to harness data from a childhood cancer data initiative Trump established during his first term, OSTP director Michael Kratsios said.

• The data initiative's budget is being doubled by this investment.
• "Leveraging this data infrastructure, researchers will deploy artificial intelligence to improve clinical trials, sharpen diagnoses, fine-tune treatments, unlock cures and strengthen prevention strategies," Kratsios said.
• For example, researchers will build scalable models to predict how a child's body responds to therapies, in order to forecast cancer progression and minimize treatment side effects.
• AI could help guide researchers to treatments in the future that "will have a higher cure rate" and fewer side effects, said National Institutes of Health director Jay Bhattacharya.

Between the lines: A White House official said the effort builds on existing technology but declined to name any companies or specific software.

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⚕️ The Trump administration issued a final plan for how it will carry out the third round of the Medicare drug price negotiations, despite ongoing opposition from the drug industry. (Bloomberg Law)