ELV (US)

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…

We think this morning’s court ruling against Humana (HUM) in its Medicare Advantage (MA) Stars litigation is likely the end of the road in its efforts to secure a higher score for its 2026 payment…

Nearly a week into the government shutdown, with the parties dug in, we continue to expect Congress to “fix” the enhanced Obamacare subsidy cliff, benefiting exchange insurers, hospitals, and behavioral health providers. The questions remain…

While reports over the weekend about CMS’s Friday release of the Medicare Advantage (MA) and Part D Plan (PDP) premium, deductible and other information for the 2026 plan year focused on the 2.6% projected cut…

Medicare Advantage (MA) insurers [HUM, UNH, CVS, CNC, ELV, ALHC] received some positive legal news that for now neutralizes the concern of widespread Medicare audits and potential concomitant recoupments. However, yesterday’s federal district court ruling…

We continue to be optimistic and think the odds have risen above 50% that Congress later this year reaches a compromise to “fix” the expiring enhanced Obamacare subsidies, which would further remove some of the…

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…

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…

While exchange insurers (OSCR, CNC, ELV) and hospitals (THC, CYH, ARDT, UHS, HCA) try to figure out their  Obamacare businesses for next year with the various regulatory and reconciliation-related changes leading to anticipated enrollment declines…

CMS’s addition last week of 300+ Medicare Advantage (MA) [UNH, HUM, CNC, ELV, CVS, ALHC] contracts to be audited for risk adjustment data verification (RADV) during plan year (PY) 2019 raises the risk of larger…