April 7, 2025
[HUM, ALHC, UNH, CNC, AGL, PRVA]: MA’s 5%+ Increase Met Our Expectations, But Longer-Term Coding and Part D Questions Remain
The final CY26 Medicare Advantage (MA) rate announcement met our previously-published optimistic expectations for a comfortable mid-single-digit YoY benchmark rate increase for MA insurers [HUM, ALHC, UNH, CVS, ELV, CNC] with CMS finalizing a 5.06% increase, largely…
April 7, 2025
Capitol Policy Weekly—April 7-11: Trade and Tax Cuts
Trade will continue to dominate the news this week, while the House is scheduled to consider the budget resolution that the Senate passed early Saturday before both chambers go out on a two-week recess at…
April 6, 2025
[HUM, ALHC, UNH] Final Medicare Advantage Tech Changes Reg: Most Proposals Dropped Without Explanation, Await CY26 Rate Notice
CMS’s final CY26 technical changes rule for Medicare Advantage (MA) and Part D plans [HUM, ALHC, UNH, CVS, ELV, CNC] lived up to expectations of rolling back proposed restrictions in response to consumer complaints, but…
April 4, 2025
[NVO, LLY] No Medicare / Medicaid Coverage for Obesity Drugs
With no more than a perfunctory reference this afternoon, CMS announces that it will not be finalizing a Biden proposal to allow Medicare Part D plans to cover anti-obesity medications (AOMs) while requiring it of…
April 4, 2025
Trade and Tariff Update: Higher for Longer?
Key Takeaways Even with the market turmoil due to the President Trump’s reciprocal tariffs, we don’t see Trump reversing course in the very near term. In fact, we believe the rhetoric on trade could get…
April 3, 2025
Senate Budget Resolution & Healthcare Offsets
In response to yesterday’s Senate budget resolution proposal and the GOP’s assumption of the current policy baseline for scoring purposes, we think Congress continues to target Medicaid, Medicare hospital site neutrality, and PBM reforms as…
April 2, 2025
Extending the TCJA Tax Cuts Cost Free—Well, Maybe
As we await President Trump’s reciprocal tariff announcement this afternoon, there was some progress on the budget resolution / reconciliation bill yesterday that could: Make passing the reconciliation / tax bill much cheaper and potentially…
March 31, 2025
Capitol Policy Weekly—March 31 through April 4: Trade, Reconciliation/Taxes/Debt Limit, Banks and Special Elections
This week looks like an important and busy week in Washington and beyond with: The Senate is seeking to pass their budget resolution by week’s end. President Trump announcing his reciprocal trade policy on April…
March 31, 2025
Procept Biorobotics: Expecting ~20% Medicare Rate Cut
With CMS likely to propose a new Medicare physician payment rate for PRCT’s Aquablation in early July – with a final policy in early Nov. and rates effective Jan. 1, 2026 – we expect to…
March 28, 2025
INSP, NYXH, LIVN: Sleep Apnea Coverage Timeline
We view the delayed approval of Nyxoah’s (NYXH) Genio announced this week as positive for Inspire Medical (INSP) insofar as it not only pushes out competition – albeit to an uncertain extent – but may…