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…
December 29, 2025
Obesity Model & “Deal” Demo Exclusions
CMS’s BALANCE Model to facilitate coverage of anti-obesity medications (AOMs) [LLY, NVO] in Medicaid and Medicare Part D (PD) (standalone and Medicare Advantage plans) – released Dec. 23 – while still lacking key details, provides…
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 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 14, 2025
[HUM] Stars Rating Litigation Likely Brings Chapter to Close
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…
September 29, 2025
Medicare Advantage: CMS’ Stable Message Eclipsed by Falling Enrollment Forecast, But A Wait and See Attitude Is Appropriate
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…