Insights: Healthcare

The Center for Medicare & Medicaid Innovation (CMMI) is in the process of developing a demonstration program which would test allowing Medicare Part D plans and state Medicaid program to cover GLP-1 products for weight loss purposes. Reports suggest the demonstration could begin as soon as Q2 next year for state Medicaid programs (~2027 for...

Drug Pricing/Most-Favored Nation

The Trump administration is escalating its efforts to compel drugmakers to offer most-favored nation (MFN) prices to American consumers (i.e., prices equivalent to those offered in the markets of countries comparable to the U.S. economically/developmentally). In recent days, the White House issued letters to more than a dozen drugmakers demanding...

Medicare Hospice Reimbursement

As part of the FY26 hospice final rule, CMS will increase hospice payments by 2.6% ($750m) relative to FY25 levels and set the annual per beneficiary payment cap at $35,361.44 (increased from $34,465.34 in FY25).

Medicare Skilled Nursing Facility (SNF) Reimbursement

As part of the FY26 SNF final rule, CMS will increase SNF payments by 3.2% ($1.16b) relative to FY25.

Medicare Inpatient Hospital (IPPS) Reimbursement

As part of the FY26 IPPS final rule, CMS will increase inpatient hospital payments by 2.8% ($4b) relative to FY25.

Pharmacy Benefit Managers (PBMs)

The U.S. District Court for the Eastern District of Arkansas has granted a preliminary injunction preventing implementation of a first-of-its-kind AR law (Act 624) that prohibits PBMs from owning or operating pharmacies in the state. In his ruling, Judge Miller found that CVS Health, Cigna’s Express Scripts, and the Pharmaceutical Care Management...