Insights: Healthcare

Affordable Care Act Subsidies

Legislative activity related to expired ACA enhanced subsidies (eAPTCs) continues to accelerate and is moving in a more bipartisan direction. Yesterday, the House passed – on a bipartisan 230-196 basis – a bill to retroactively extend the subsidies for three years (through 2028). This bill was the result of a rarely-used “discharge...

Skin Substitutes

CMS’s Medicare Administrative Contractors (MACs) are withdrawing the Local Coverage Determination (LCD) for “Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers” scheduled to become effective on January 1, 2026.

ACOs (LEAD Model)

The CMS Innovation Center (CMMI) announced the Long-Term Enhanced ACO Design (LEAD) Model, the successor to the soon-to-conclude ACO REACH model.

Drug Pricing/Coverage (GLP-1s)

The CMS Innovation Center (CMMI) announced the Better Approaches to Lifestyle & Nutrition for Comprehensive Health (BALANCE) model, which will test Medicare/Medicaid coverage of GLP-1 drugs for weight loss purposes.

Most Favored Nation Deals, Medicare Pricing (GLOBE/GUARD)

On Friday, the White House announced it has reached voluntary drug price reduction agreements with another nine drugmakers. Shortly after that announcement, the CMS Center for Medicare & Medicaid Innovation (CMMI) released proposed rules governing two payment models (GLOBE and GUARD) that will impose most-favored-nation (MFN) pricing in the...

Pharmacy Benefit Managers (PBMs)

Senate Finance Committee Chair Crapo (R-ID) and Ranking Member Wyden (D-OR) introduced the Pharmacy Benefit Manager (PBM) Price Transparency & Accountability Act.