UNH (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…

We remain optimistic that home health companies [EHAB, PNTG, ADUS, BTSG, UNH, AVAH] will secure some mitigation in the final CY26 Medicare reimbursement rule, which may be released as early as month’s end and as…

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…

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…

With slightly more than two weeks left in CMS’s comment period for the CY26 Medicare reimbursement proposal rule for home health [PNTG, EHAB, BTSG, ADUS, AVAH, AMED, UNH], we continue to expect mitigation from CMS’s…

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…

Hospitals [CYH, ARDT, UHS, THC, HCA] were on the losing end of the stick under CMS’s proposed CY26 Medicare reimbursement rule for hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs) for a variety of…

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…