June 1, 2026
CLOV Star Ratings Legal Win Creates System Uncertainty but Potentially Strengthens HUM Appeal
Last week’s federal court ruling in favor Clover Health (CLOV) against CMS injects fresh uncertainty into the Medicare Advantage (MA) Star Ratings and quality bonus payment framework [UNH, HUM, ELV, CVS, ALHC, CNC, MOH]. While…
May 12, 2026
UNH’s Flat-Fee PBM Model Seems in Response to Rivals and Regulators [UNH, CI, CVS]
UNH’s new Optum Rx model, which shifts PBM and group purchasing organization compensation in its commercial business toward transparent flat fees, appears designed to modestly outpace similar transparency initiatives from CI and CVS while aligning…
May 7, 2026
Medicare Advantage: Policy Risk Panoply
With 1Q26 earnings now largely complete for the major Medicare Advantage (MA) insurers [UNH, HUM, ALHC, CVS, ELV, CNC, MOH], near-term MA policy risks remain less acute, though far from extinguished. Congressional cuts remain unlikely…
April 21, 2026
Another State PBM Ban on Pharmacies Invites Headline Noise – and Ultimately Legal Challenges [CVS, CI, UNH]
While the passage of another ban on PBM ownership of pharmacies – this time in Tennessee – could reignite some headline risk for CVS, CI, and UNH, we think the actual risk of it going…
April 21, 2026
Being Coy on BALANCE – How Could CMS and Insurers Get to Yes [UNH, ELV, HUM, CVS, CNC, CI, MOH]
UnitedHealth’s (UNH) comments on its earnings call this morning, responding to a question about potential participation in CMS’s BALANCE obesity drug model, suggest that further design changes will be required for it – and likely…
April 6, 2026
Medicare Advantage: CY27 Final Rates Provide Expected Relief, Longer-Term Risks Punted or Persist [HUM, ALHC, UNH, CVS, ELV, CNC, PRVA, ASTH, EVH]
The final CY27 Medicare Advantage (MA) rate announcement, reflecting a net 2.48% YoY benchmark increase, landed within our expectations and alleviates some of the near term-pressure on MA insurers [HUM, ALHC, UNH, CVS, ELV, CNC]…
March 16, 2026
Medicare Advantage: Final CY27 Rates Expectations of 1%-3% Increase [HUM, ALHC, UNH, CVS, ELV, CNC, PRVA, ASTH, EVH, DVA, FRE.DE]
We continue to expect CMS’s final CY27 rate announcement for Medicare Advantage (MA) insurers [HUM, ALHC, UNH, CVS, ELV, CNC], affecting their contracted value-based care providers [PRVA, ASTH, EVH], to produce a low single-digit increase…
March 2, 2026
CMS’s ELV Sanction Warnings Sends MA Risk Adjustment Message, But Does It Up the Ante on a Broader Crackdown?
CMS’s warning letter against ELV of potential sanctions on new Medicare Advantage (MA) enrollment underscores another enforcement lever the agency can deploy to curb improper risk adjustment behaviors and overpayments. As the agency remains committed…
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,…