HRSA Finalizes 340B Rebate Pilot
The Health Resources and Services Administration (HRSA) finalized a revamped version of its contentious 340B Rebate Model Pilot Program after public comment. Earlier, a judge had struck the pilot due to regulatory deficiencies. The new pilot would move from upfront discounts to retrospective rebates for some drugs. Another Trump proposals would reduce Medicare drug reimbursement for 240B providers to ensue no double-dipping on discounts. The revised pilot is now set to begin on Jan. 1, 2027 and will run for at least a year.
In other news, a Health Affairs Forefront blog says there could be duplication of discounts between the Medicare drug price negotiation program and 340B as well.
Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-340b-drugs-rebate-pilot-hrsa-safety-net/
(Some articles may require a subscription.)
#340b #drugpricing #hospitals #providers
United Reports Cost Surge For Fully Insured
UnitedHealth Group’s Center for Health Care Research reports that total medical costs for fully insured individuals rose 9% per person in 2025. The estimates are based on 2024 and 2025 UnitedHealthcare claims.
Prescription drugs represented about one quarter of total medical spending but accounted for more than 40% of the year-over-year increase. Drug costs grew 14%. Utilization of specialty drugs rose 13%, brand drugs 6%, and administered drugs 21%.
Total per-member costs reached $8,758 in 2025, up from $8,036. Hospital inpatient spending rose 8%, outpatient costs grew 8%, and physician spending 4%.
#healthplans #coverage #spending
Alignment Healthcare Soars
Alignment Healthcare posted $1.34 billion in revenue for Q2 2026, up almost 32%. It also reported $182.9 million in adjusted gross profit, up about 35. Health plan membership at the end of Q2 was approximately 294,100 members, up almost 32%. The company’s medical loss ratio (MLR) was 86.3% — solid compared with others.
Additional article: https://www.beckerspayer.com/financial/alignment-records-32-increase-in-membership/
#alignmenthealthcare #medicareadvantage #margins
https://www.fiercehealthcare.com/payers/alignment-boasts-316-revenue-increase-q2-boosts-2026-outlook
Hospital and Joint Rule Finalized
The Centers for Medicare and Medicaid Services (CMS) finalized its 2027 hospital rule which gives a 2.3% increase for base inpatient hospital payments for fiscal year 2027. It also delayed the launch of the CJR-X Model, a mandatory nationwide episode-based payment model for certain joint replacement. It will now start January 1, 2028. Hospitals oppose a nationwide rollout.
Numerous financial and quality measurement changes are also made to various value-based care models.
Additional articles: https://www.fiercehealthcare.com/providers/cms-locks-23-inpatient-hospital-base-pay-increase-nudges-back-cjr-x-model-start-date and https://www.modernhealthcare.com/politics-regulation/mh-hospital-inpatient-final-rule-2027/ and https://www.cms.gov/newsroom/fact-sheets/fy-2027-hospital-inpatient-prospective-payment-system-long-term-care-hospital-prospective-payment and https://www.cms.gov/newsroom/press-releases/cms-news-cms-announces-nationwide-expansion-proven-joint-replacement-program
(Some articles may require a subscription.)
#medicare #vbc #hospitals #providers
States Again Challenge Exchange Rule
States have filed another lawsuit challenging recent finalization of Exchange regulations. The rule allows broader access to catastrophic plans, Bronze and catastrophic plans with greater cost-sharing, and stricter income verification checks during special enrollment periods. Pieces of the rule have already been struck by another court.
(Article may require a subscription.)
#exchanges #regulations
https://www.modernhealthcare.com/legal/mh-aca-rule-lawsuit-california-bonta-new-jersey-davenport
MA Exits Already Announced For 2027
Becker’s Payer is already cataloguing exits from Medicare Advantage (MA) for 2027.
- Humana will exit certain markets and impact 600,000 enrollees.
- Clear Spring Health will exit its Illinois, Georgia, and Colorado markets.
- Molina Healthcare will no longer offer its MA-Part D product in 2027. The company is focusing exclusively on its dual-eligible Special Needs Plan products.
- Providence is closing most of its health plan, based in Portland, Ore., in 2027. The future of its MA offerings is still unknown as the MA line may be sold.
- Presbyterian Healthcare Services will discontinue most of its MA plans in New Mexico in 2027.
#medicareadvantage #enrollment
— Marc S. Ryan
