June 22, 2025
Obamacare: Program Integrity Rule Meets Overall Expectations, Though Relative Slight Improvement; Risk Remains
Amidst the behind-the-scenes Senate debate of its draft reconciliation bill, CMS made good on its threat to jettison improper and fraudulent Obamacare enrollment, impacting ACA insurers [OSCR, CNC, ELV, MOH] and hospitals / behavioral facilities…
June 18, 2025
Rx Advertisements & RFK: Legal Guardrails
Amid reports that HHS is considering steps to curtail direct-to-consumer (DTC) drug advertisements – with negative implications for high spenders in this area [ABBV, NVO, REGN] – we see significant impediments to how far /…
June 17, 2025
Healthcare: Thoughts on the Senate Finance Draft’s Healthcare Provisions
The Senate Finance Committee’s (SFC) draft healthcare and tax portion of the reconciliation bill makes some changes, relative to the House-passed measure, but is overall consistent with that version, with the implications being lower Medicaid…
June 16, 2025
Medicare Advantage: Filling in RADV Blanks; HUM Has Most Contracts Targeted [HUM, UNH, CVS, ELV, CNC, ALHC]
Late Friday, CMS announced the latest list of Medicare Advantage (MA) contracts to be targeted for risk adjustment data verification (RADV) audits – this time for payment year (PY) 2019 – and its associated processes…
June 16, 2025
(FLTR, DKNG, MGM, CZR) Sports Gambling Update: Risks Remain
In light of the weighty sports betting tax hike in Illinois over the weekend and the modest increase in Maryland last week, investors should continue to expect tax hikes in various states offset at times…
June 16, 2025
Capitol Policy Weekly: June 16-20: Reconcilation, the G-7 and Stablecoins
The early part of this week will be busy with the Senate Finance Committee expected to release today its version of the reconciliation bill, which includes the important tax and Medicaid/health care portions of the…
June 13, 2025
PBMs: State Legislative Risks Persist Through Session Ends [CI, CVS, UNH, HUM, ELV, Navitus]
With many 2025 state legislative sessions having concluded, pharmacy benefit managers (PBMs) have – for the moment – successfully avoided various bills seeking to aggressively curb industry practices, except for a few new laws in…
June 12, 2025
Lantheus (LNTH): Where Do Hospital Rates Go?
Despite some speculation, we do not expect CMS to increase hospital payments for LNTH’s Pylarify from CY25’s mean unit cost (MUC) [$3.1K] to an average sales price (ASP) methodology [$5.8K] (+85%) in the draft CY26…
June 11, 2025
Section 899 of the Reconciliation Bill Conference Call Takeaways
Below are our takeaways from our recent conference call on the controversial Section 899 of the reconciliation bill as well as thoughts on related developments and what that might mean for the provision in question….
June 10, 2025
Lab Tools: Senate’s NIH Pushback
Today’s hearing on the FY26 NIH budget before a Senate Appropriations Subcommittee bolsters our view [see note] that lawmakers are highly unlikely to endorse the White House request for an $18B (40%) cut, with flat…