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…
January 13, 2025
Capitol Policy Weekly: Jan. 13-17
This week starts a host of hearings on President-elect Trump’s cabinet nominees (see below). The Senate is also expected to pass an immigration bill, the Laken Riley Act (S. 5), which would require the Dept….
January 12, 2025
Diagnostics’ New Supreme Court Risk
The Supreme Court’s (SCOTUS) decision on Friday to hear oral arguments in Becerra v. Braidwood, presumably in late March / early April, will likely serve as an overhang for screening test manufacturers [EXAS, GH, MYGN,…
January 11, 2025
[HUM, UNH, CVS, ELV, ALHC] CY26 Medicare Advantage Rates: Likely Upswing in the Final
CMS’s Friday release of the CY26 Advance Notice (AN) for Medicare Advantage (MA) insurers [HUM, UNH, CVS, ELV, ALHC, CLOV, CNC] came in better than our net YoY benchmark expectations with a proposed net increase…
January 10, 2025
Medtronic (MDT): Renal Denervation Coverage Read-Through?
This morning’s opening of a Medicare National Coverage Determination (NCD) for privately-held Impulse Dynamics’ Optimizer System bolsters our view that coverage for renal denervation (RDN) systems [Medtronic (MDT), Otsuka / ReCor (4578.JT)] is unlikely to…
January 10, 2025
2025 Tax Primer: Extending the Trump Tax Provision et al.
We continue to believe that Congress is likely to pass a massive $5 trillion- plus tax bill that would extend the 2017 Trump tax cuts, known as the Tax Cut and Jobs Act (TCJA). We…