July 14, 2025
PRCT: Pro Fee -28%, Competitor -25%
CMS’s draft CY26 Physician Fee Schedule (PFS) released this evening would reduce payments for PRCT’s Aquablation by -28% in 2026, going from a volume-weighted average of $765 across the seven Medicare Administrative Contractors (MACs) to…
July 11, 2025
[MDT, Otsuka] Renal Denervation: Broad Coverage, With Constraints
We view CMS’s coverage proposal for renal denervation (RDN) [Medtronic (MDT), Otsuka (4578.JT)] as an incremental positive relative to our expectations, but likely to be largely in line in terms of its effects. With patients…
July 8, 2025
[LNTH, TLX.AU] Pylarify Competitor Pass-Through Precursor
In what we view as a harbinger of a competitive headwind for LNTH’s Pylarify, CMS this morning provided a unique billing code for TLX.AU’s Gozellix (A9616) to differentiate it from its predecessor drug Illuccix (A9596)….
July 1, 2025
[DXCM, TNDM, BBNX, RMD, CTEC.LN, COLOB.DC] Medicare Competitive Bidding Coming
Consistent with our long-held expectations – albeit coming sooner than we had anticipated – a draft CMS rule issued last night strongly suggests it intends to subject continuous glucose monitors (CGMs) [DXCM, ABT] and insulin…
June 30, 2025
[LIVN, INSP, GMED, MMSI, BSX, MDT] CMS Prior Auth Demo Device Headwinds
We view CMS’s new Medicare prior authorization model – announced late Friday and scheduled for implementation Jan. 1, 2026 – as an incremental headwind for device manufacturers within the selected therapeutic and geographic areas, which…
June 27, 2025
[EXAS, GH, GILD, MYGN, HOLX] Preventive Services: SCOTUS Takes
Consistent with our expectations, the Supreme Court today upheld the validity of U.S. Preventive Services Task Force (USPSTF) appointments and – by extension – the mandate that insures cover recommended services without patient cost-sharing, lifting…
June 27, 2025
PRCT: Medicare Rate Expectations
With CMS likely to publish its CY26 physician / hospital outpatient rate proposals the week of July 7-11, we continue to expect physician payments for PRCT’s Aquablation to fall ~20% ($765 to ~$600) [see prior…
June 24, 2025
[EW] Quick Word on TAVR Coverage Update
Having received a number of questions on an “update” posted to CMS’s National Coverage What’s New Report yesterday – which some have taken to imply a near-term reopening of the agency’s coverage policy for transcatheter…
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 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…