HUM (US)

This morning’s House Energy and Commerce Health Subcommittee hearing on “needed” pharmacy benefit manager (PBM) reforms attempted to reinvigorate the past bipartisan and bicameral consensus for legislative changes to rein in the PBMs, but until…

Today’s reaction to the WSJ report that UnitedHealth (UNH) is under civil investigation by the DOJ for Medicare False Claims Act violations strikes us as overwrought, with ultimate financial liabilities (still 1-2 years away) unlikely…

We expect Humana (HUM) to ultimately prevail in its lawsuit against HHS to secure higher 2025 Medicare Advantage (MA) star ratings, but it may take longer than we originally expected (as early as March-April). While…

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…

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,…

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…

Following Tuesday night’s release of a short-term continuing resolution (CR) funding the government through March 14, we outline some key differences from previously-reported iterations of the healthcare extenders package, involving PBMs [CI, CVS, UNH, ELV],…

KEY TAKEAWAYS: We expect the proposed YoY change in the CY26 benchmarks for Medicare Advantage (MA) plans is likely to be relatively flat, with a range between -1% and +1% that excludes coding trend, but…

President Trump’s surprise and unorthodox nomination of Dr. Mehmet Oz to be CMS administrator, whom we presume will likely be confirmed, affords somewhat of a blank slate for others in the administration to fill in…

Key Takeaways:  Changes to Medicare home health payments live up to expectations of a minimal increase, but with future negative adjustments following CMS’s release of its CY25 final rule Friday. As we wrote in mid-October,…