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Consistent with our prior note, we continue to assign 60%-65% odds that the Trump administration suffers at least a partial loss in the International Emergency Economic Powers Act (IEEPA) case currently pending before the Supreme Court (SCOTUS). Importantly, the Court…

With the start of the new year and holdover of some key issues from 2025, 1Q26 promises various policy catalysts across the health insurer and provider landscapes, informing company growth and revenue prospects for the…

With Medicare Administrative Contractor (MAC) WPS – responsible for ~13% of INSP claims – now joining Noridian (17%), NGS (9%), and CGS (6%) in removing cranial nerve code 64568 from its hypoglossal obstructive sleep apnea…

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…

CMS’s mandatory Medicare Part D (here) / Part B (here) international drug pricing model proposals released Friday suggest that – besides an ostensible reprieve from as yet unrealized tariffs – recent drug manufacturer “deals” with…

Despite this morning’s billing article updates from Medicare Administrative Contractors (MACs) Noridian [here] and CGS [here] – removing CPT 64568 from the list of covered codes for hypoglossal nerve stimulation (HGNS) for obstructive sleep apnea…

As we enter 2026, we highlight the following four states that we believe are the most likely candidates to at least consider raising their online sports betting tax for DraftKings (DKNG), Flutter’s FanDuel (FLUT), MGM…

Today’s news that four House Republicans joining House Minority Leader Hakeem Jeffries’ (D-NY) discharge petition for a straight three-year extension of the enhanced Obamacare subsidies – and with House GOP leadership narrowly passing its own…

While an improvement from the skin substitute coverage policies that have been delayed since Nov. 2024, CMS’s updated intentions risk prolonging uncertainty for the likes of CTEC.LN, MDXG, and ORGO, as well as benefits for…