February 4, 2026
CI Proposed FTC Settlement: What Might It Mean for PBMs? [CI, UNH, CVS, ELV, PGNY, CNC, HUM]
Cigna’s (CI) proposed settlement with the FTC over antitrust allegations regarding its PBM pricing, rebating and formulary practices around insulin likely establishes the basic framework that UNH and CVS will have to match to resolve…
January 26, 2026
Medicare Advantage: CMS’s Negative Surprise of Flat Rates and Risk Adjustment Changes – What Now?
CMS’s negative surprise to Medicare Advantage (MA) insurers [HUM, UNH, ALHC, CVS, ELV, CNC] – which is also likely to spill over into weakness among insurers less or not exposed to this market [MOH, OSCR,…
January 21, 2026
Insurer Policy Concessions, Political Theater, & the Limits of Cost Reforms [UNH, CI, CVS, ELV]
While UNH’s announcement this morning that it will rebate its expected 2026 ACA profits has drawn the most attention – and may pressure other Obamacare insurers [ELV, CI, HUM, CNC, OSCR, MOH] to make similar…
January 20, 2026
CORRECTED: PBMs: Latest Spending Draft’s Watered-Down Reforms Are Incremental, Not Transformational [UNH, CVS, CI, CNC, ELV, HUM]
The latest draft of the government spending bill, released early this morning, presents an even more manageable policy outcome for pharmacy benefit managers (PBM) [UNH, CVS, CI, CNC, ELV, HUM] than previously expected; it revives…
November 26, 2025
Medicare Advantage Tech Changes Proposal: RFI Eases Risk Adjustment Concerns, Star Rating Changes Afoot [HUM, ALHC, UNH, CVS, ELV, PRVA, ASTH]
Our read of the proposed Contract Year 2027 Policy and Technical Changes regulation for Medicare Advantage (MA) and Part D (fact sheet here), confirms our expectations for a positive regulatory backdrop for 2027 for MA [HUM, ALHC,…
November 9, 2025
Obamacare HIX Fix: HSAs for All or Compromise on Subsidy Changes? We Still Think the Latter [OSCR, CNC, ELV, MOH, UNH, HQY, WBS, EHTH]
President Trump’s Truth Social posts over the weekend, along with that of other Republicans, suggest an existential threat for Obamacare insurers [OSCR, CNC, ELV, MOH, UNH] and potentially other commercial health insurers [CI, CVS] while…
November 7, 2025
Obesity Drug Pricing Deal: Devil in the Details
As outlined by the Trump administration, we view yesterday’s obesity drug pricing deal with NVO and LLY as a modest near-term positive (potentially better for LLY), with the $245 / mo. price point for Medicare…
November 5, 2025
Medicare Advantage: Still Expecting Light Regulatory Touch for CY27 [HUM, ALHC, AGL, UNH, CVS, ELV, CNC, PRVA]
Listening to recent earnings calls held by various Medicare Advantage (MA) insurers and value-based care providers [HUM, ALHC, AGL, UNH, CVS, ELV] leaves us with the following thoughts on the MA regulatory policy environment for…
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…