April 10, 2025
[CVS, CI, UNH]: Senate Confirmation of 3rd FTC Commissioner Allows for Future Resumption of PBM Litigation
Today’s successful Senate confirmation of Mark Meador to join the FTC as a commissioner paves the way for the FTC to officially resume its antitrust litigation against the pharmacy benefit managers (PBMs) [CVS, CI, UNH,…
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 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 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…
March 25, 2025
HUM, ALHC, UNH: Optimistic for Mid-Single Digit MA Rate Increase for CY26, Upcoding Remains a Longer-Term Issue
Anticipating CMS’s issuance of its final CY26 Medicare Advantage (MA) rate notice within the next two weeks (on or before Monday, April 7), we remain optimistic about near-term regulatory changes for MA insurers [HUM, ALHC,…
March 14, 2025
Oz Nomination: Moving towards Senate Confirmation, Medicare Advantage Comments Show Mixed View
Today’s Senate Finance Committee confirmation hearing of Dr. Mehmet Oz as Trump’s CMS Administrator provided limited new insights into his approach to Medicare, Medicaid, Obamacare, pharmacy benefit management reforms, health savings account adoption, and healthcare…
March 10, 2025
[OSCR, ELV, CNC, HCA, THC]: Targeting Obamacare Program Integrity in Rulemaking and Legislation
With all eyes focused on whether Congress will extend the enhanced ACA subsidies or let them lapse – we remain optimistic of a middle ground (revision and extension) – we caution investors about the headline…
March 5, 2025
Diving Deeper on Outlook for Hospital-Targeted Medicaid Reforms [ARDT, CYH, HCA, THC, UHS, municipal-backed hospitals]
We do not see any let-up any time soon on policy-related headwinds confronting hospitals [ARDT, CYH, HCA, THC, UHS, municipal-backed systems] as Congress hunts for palatable reconciliation savings. While many of the circulated Medicaid ideas,…
February 26, 2025
[CI, CVS, UNH, HUM, ELV, GDRX]: House Hearing Retreads Already Agreed-to PBM Reforms, Still Likely as Legislative Payfors
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…
February 23, 2025
Medicaid Reform Watch: Still Early On – What to Watch for [CNC, MOH, ARDT, CYH, ENSG, ADUS]
As the budget resolution process and subsequent reconciliation strategy unfolds, Medicaid reforms that have posed headline enrollment and payment risk to Medicaid insurers [CNC, MOH, ELV], dual eligible insurers [UNH, HUM, ELV, CVS],hospitals [ARDT, CYH,…