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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…

Coming roughly in line with our timing expectations outlined in early June (admittedly, a quarter or so early), we would expect CMS’s reopening of its transcatheter aortic valve replacement (TAVR) coverage policy to provide greater…

This is the last week the House and Senate will be in session until the week of January 5. Hence, we see some notable items that investors should be interested in:   House vote on a…

Having received a large number of questions on whether Medicare Administrative Contractors (MAC) might refuse to cover INSP’s Inspire V device under CPT 64568 following CMS’s recent facility rate increase via assignment to a New…

We see growing uncertainty for the trajectory of defense spending beyond FY26 due to several policy-related crosscurrents:  Recent comments from OMB Director Russ Vought signaling potential use of a reconciliation bill next year to increase…