Insights: Clients

Medicare Extenders

Republican Congressional and committee leaders are working to develop a “continuing resolution” (CR) to extend FY25 funding/appropriations beyond the current 3/14 deadline. Lawmakers are jockeying to have their preferred “riders” (provisions extraneous to ordinary annual government funding) added to that measure and in recent days, Rep. Murphy...

The Republican leaders of the House and Senate Appropriations Committee (Rep. Cole (R-OK), Sen. Collins (R-ME)) are now developing two different “continuing resolutions (CRs)" to extend FY25 funding/“appropriations" beyond the current 3/14 deadline. One would extend funding at current levels for one month and provide time to finish negotiations...

President Trump decided to put in place 25% tariffs on imports from Mexico and Canada (10% for Canadian energy imports) that had been paused since for the last month, and he imposed an additional 10% tariff on Chinese imports. The White House fact sheet announcing the tariffs primarily focuses on fentanyl shipments as the rationale for taking...

Late last week, the FDA issued a Declaratory Order determining that the semaglutide drug shortage has been resolved and announcing that the drug (the active ingredient in Ozempic, Rybelsus, and Wegovy) would be removed from the agency’s 506e shortage list. Just days later, the Outsourcing Facilities Association (OFA) – which represents the...

Pharmacy Benefit Managers (PBMs)

Earlier this week, the House Energy & Commerce (E&C) Health Subcommittee held a hearing to discuss the practices of PBMs and set the table for possible legislative reforms this year.

Medicare Advantage (MA)

Improper upcoding by MA plans is gaining some visibility amongst regulators and policymakers. Last week, it was reported that the DOJ had initiated a civil fraud investigation into UnitedHealth’s MA billing practices, focusing on whether the company recorded questionable diagnoses to secure higher payments for its MA plans. And following the...