UNH (US)

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…

The recent public clash between CMS Administrator Mehmet Oz and California Governor Gavin Newsom (D-CA) over Medicare fraud has renewed questions about whether the hospice industry [CHE, BTSG, PNTG, ADUS, AVAH, UNH, private Elara Caring…

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,…

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…

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…

President Trump’s long-teased “Great Healthcare Plan”, released this morning, does little to meaningfully move the needle on healthcare redesign or cost containment beyond our prior expectations for legislative action affecting Obamacare insurers, non-ACA managed care…

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…

Home health (HH) agencies [PNTG, EHAB, BTSG, ADUS, AVAH, UNH] received meaningful relief in Friday’s final CY26 Medicare HH reimbursement rule, which pares back the proposed aggregate spending cut and rate discounts. However, CMS signals…

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,…

Ambulatory surgery centers (ASCs) [SGRY, AmSurg, THC, HCA, UNH] secured some policy wins in the final CY26 Medicare outpatient prospective payment system (OPPS) rule, consistent with the July proposal (notably a broadened covered procedure list,…