January 21, 2025
Guardant (GH) Reveal Medicare Coverage FAQ
Following GH’s announcement this AM of Medicare coverage of its tissue-naïve Reveal test for minimal residual disease (MRD) surveillance testing, we wanted to highlight some additional salient points omitted from the company’s press release. The…
January 20, 2025
Capitol Policy Weekly: Jan. 20-24—Inauguration Special
We expect some potential market moving action this week in relation to: 1) President-elect Trump’s inauguration, 2) his potential executive orders (EOs) and 3) his public comments. Trump has promised 100 EOs in the first…
January 17, 2025
[NVO, BHC, TEVA] Quantifying IRA Price Negotiation Risks
Our analysis of the drugs included in the CY27 cycle of price negotiations under the Inflation Reduction Act (IRA) announced this morning implies a 3%-4% headwind for NVO relative to consensus CY27 revenues, with a…
January 17, 2025
MedPAC Provider Recs Likely to Be Ignored in Favor of Savings Targets Like Site Neutrality, Medicaid, Rule Repeals
We doubt Medicare Payment Advisory Commission’s (MedPAC) FY/CY26 Medicare payment recommendations for home health agencies, inpatient rehab facilities, skilled nursing facilities, hospices, dialysis centers, hospitals, and physician offices, which were voted on Thursday in nearly…
January 16, 2025
FY25 Defense Spending Iis Likely to Come in Above Our Expectations
Our long-held belief has been that defense spending for FY25 would clock in at ~$920 billion; however, that figure seems too low in our view, given the recent news flow. We now believe defense spending…
January 16, 2025
UNH: Though Confident, Public Policy Questions Remain
UnitedHealth’s (UNH) comments during its 4Q and full year 2024 earnings call about changes its it taking to head off certain public policy concerns (PBMs, prior authorization/claim denials) seem like the company is in catch-up…
January 15, 2025
(DKNG, FLUT, CZR, MGM) Sports Betting Policy Update
We see little positive legislative movement for the sports gambling sector [DKNG, FLUT, CZR, MGM], since we do not expect any of the 11 states that have yet to legalize the practice to make further…
January 14, 2025
[CVS, CI, UNH]: FTC 2nd (Negative) Report on PBMs Doesn’t Change Overhang Trajectory
The FTC’s unanimously-supported release of its second interim report on pharmacy benefit managers (PBMs), focused on specialty drug dispensing at affiliated pharmacies [CVS, CI, UNH] that generated an extra $7.3B in revenue over six years,…
January 13, 2025
Medtronic: Medicare RDN Coverage in 4Q24
In keeping with expectations laid out in our note late last week, CMS’s opening of a National Coverage Analysis (NCA) for renal denervation (RDN) [Medtronic (MDT), Otsuka (4578.JT) / ReCor] this afternoon has a target…
January 13, 2025
Inspire V Payment & Coverage Quick Take
INSP’s disclosure today that physicians will likely be billing its Inspire V device procedures under CPT 64568 ($596) during a “transition period” – rather than existing Inspire IV code CPT 64582 ($816), as we had…