October 17, 2025
Trump’s Fertility Push May Cut Costs, But Adoption Barriers May Remain [PGNY, Maven, Carrot, MRK.GY]
The Trump administration’s new guidance on employer-sponsored fertility benefits and deal with Merck KGaA’s (MRK.GY) EMD Serono to sell select fertility drugs at most-favored-nation (MFN) prices, which were announced Thursday, boosts visibility for companies like…
October 15, 2025
PBMs: Policy Headwinds Persist with Some New Developments [CVS, CI, UNH, ELV]
Policy headwinds facing pharmacy benefit managers (PBMs) [CVS, CI, UNH, ELV] remain entrenched despite shifting details since this spring. Recent developments, like California’s PBM law, White House drug pricing efforts, and the FTC litigation, underscore…
August 18, 2025
[CVS, CI, UNH, ELV]: CA’s PBM Reform Bill Appears Next Up in PBM Fight
With California’s legislature coming back Monday from its summer recess for its final few weeks of the regular session, pharmacy benefit manager (PBM) legislation is still on the docket and likely to invite headline risk…
August 7, 2025
Health Insurer / Provider Legislative Agenda: Band-Aid Likely in September CR, More Substantial Package Potentially Later in the Year
With the August recess in full swing for the next few weeks, the various healthcare-related legislative items on Congress’s to-do list (see below) remains lengthy for the rest of the calendar year. We are still…
July 28, 2025
CY26 Medicare Part D: Additional Spending but CMS Starting to Put on the Brakes
Today’s CMS release regarding its CY26 Medicare Part D program gives the impression the agency is focusing on stability in its drug benefit program with the goal to ensure 1) enrollees – especially those in…
June 13, 2025
PBMs: State Legislative Risks Persist Through Session Ends [CI, CVS, UNH, HUM, ELV, Navitus]
With many 2025 state legislative sessions having concluded, pharmacy benefit managers (PBMs) have – for the moment – successfully avoided various bills seeking to aggressively curb industry practices, except for a few new laws in…
May 19, 2025
Expected Federal Report on Fertility Benefits: Regulatory Recommendations Likely Incremental [PGNY]
Since we are at the 90-day mark after February 18 release of the White House’s Executive Order (EO) supportive of in-vitro fertilization (IVF), there is a hope that the Trump administration’s anticipated report of potential…
May 13, 2025
[ELV, CNC, MOH, UNH, CVS] CMS Managed Care Provider Tax Proposal
Yesterday’s CMS proposal confirms our suspicion that the agency would seek to tighten state provider taxes – primarily those on managed care [ELV, UNH, CNC, MOH, CVS, CI, OSCR]– used to secure sizable federal Medicaid…
May 7, 2025
PBMs: Death by a Thousand Cuts? [CI, CVS, UNH, ELV, GDRX]
The list of potential state and federal legislative threats to pharmacy benefit managers (PBMs) [CI, CVS, UNH, ELV, GDRX] seems to be growing, even though there has not been widespread enactment of these bills. Putting…
April 10, 2025
[CVS, CI, UNH]: Senate Confirmation of 3rd FTC Commissioner Allows for Future Resumption of PBM Litigation
Today’s successful Senate confirmation of Mark Meador to join the FTC as a commissioner paves the way for the FTC to officially resume its antitrust litigation against the pharmacy benefit managers (PBMs) [CVS, CI, UNH,…