Marc Ryan

Trump Seeks To Make Medicare Drug Price Negotiations Permanent In Regulation The Trump administration and the Centers for Medicare & Medicaid Services (CMS) have proposed to codify the Biden-era Medicare Drug Price Negotiation Program — a fantastic turn of events that few would have predicted a few years ago despite Trump’s sympathies for drug price reform. They say the move will create a more transparent and sustainable process for lowering drug costs for millions of Medicare beneficiaries. There are a number of small concessions to drug makers as well. I have given President Trump great credit for making a huge impact on drug pricing, more than any other recent president. This is more evidence. Additional articles: https://www.cms.gov/newsroom/press-releases/cms-proposed-rule-locks-lower-prices-fosters-innovation-medicare-drug-price-negotiation-program and https://www.cms.gov/files/document/mdpnp-nprm-fact-sheet.pdf #drugpricing #cms #medicare #partd #medicareadvantage #pdp https://www.fiercehealthcare.com/regulatory/cms-proposes-permanent-framework-medicare-drug-price-negotiations Democrats Search For The Next Obamacare Democrats are seeking to find their next Obamacare to win votes in the midterms. Lawmakers and policymakers are

Healthcare Cost Projected To Soar PwC says health plans expect commercial healthcare costs to climb 9% in 2027. Payers say increased use of artificial intelligence tools by health systems, hospitals and medical practices are in part to blame. AI is documenting greater specificity and reimbursable severity without proportionate increases in care intensity. Further, there is the growing use of expensive drugs, proliferation of mental health issues, and higher reimbursement demands. A survey by Mercer says U.S. companies plan to charge more for employee health plans next year. Additional articles: https://www.fiercehealthcare.com/payers/healthcare-costs-poised-jump-9-2027-health-plans-blame-ai-adoption-drug-prices and https://www.modernhealthcare.com/insurance/mh-health-insurance-costs-mercer-survey/ (Some articles may require a subscription.) #employercoverage #healthcare #costs https://www.modernhealthcare.com/providers/mh-healthcare-costs-2027-pwc-report Hospitals Don’t Like Rate Hike Or Joint Model Hospital groups want the Centers for Medicare and Medicaid Services’ (CMS) proposed annual pay rate increase of 2.4% for inpatient care to be increased. Further, it wants the agency to reconsider a mandatory bundled-payment joint replacement model. #hospitals #margins #medicare

Clover May Get Stars Reset The Centers for Medicare and Medicaid Services (CMS) could reset Clover Health’s SY 2026 rating for its largest contract after it won a lawsuit challenging the validity of some 20 measures. The health plan announced that CMS has recalculated the rating and advised the plan to submit an alternaive 2027 bid. If the recalculation is applied, all of Clover Health’s 156,000 Medicare Advantage members would now be enrolled in plans rated at least four of five stars, generating some $120M in bonus payments in 2027. But the “recalculation” is code for “we were directed to do so by the court and we likely are appealing the ruling.” So a small positive step, but not definitive for Clover yet. In essence, we still have pending litigation. After the recent Clover ruling, Humana advised the court in its lawsuit of the Clover decision. Now, the judge in

CMS Takes Tough Stance On Price Transparency Violations More than 500 hospitals received warnings from the federal government since April for non-compliance on the hospital price transparency regulation. Further notices could be sent soon. Hospitals receive an initial 90-day warning with instructions to correct any deficiencies. A subsequent 45-day deadline is sent requiring a more concrete plan to address deficiencies. If hospitals remain out of compliance, sanctions can run as high as $5,500 per day or over $2 million per year. Additional article: https://www.modernhealthcare.com/providers/mh-cms-hospital-price-transparency-data/ (Some articles may require a subscription.) #pricetransparency #hospitals #cms https://www.fiercehealthcare.com/providers/hundreds-hospitals-warned-over-price-transparency-failings-ap-reports Employers To Shake Up PBM Contracts A Pharmaceutical Strategies Group survey concludes health plans are thinking about shaking up how they manage pharmacy benefits due to surging costs. Among strategies include different drug pricing arrangements, rejecting single pharmacy benefit models, and embracing third-party vendors. Some are unbundling traditional pharmacy benefits manager services, looking for the best deal

Many Unaware Of Coming Work Rule A Health Management Academy survey finds that about 55% of Medicaid enrollees say they are unaware of upcoming work requirements. Work requirements go into effect on January 1 under the One Big Beautiful Bill Act. Many enrollees don’t know they’ll need to report work, education or volunteer hours starting in less than six months in order to stay covered. Another 27% said they knew something about work requirements but were unsure of the details. While the vast majority of Medicaid enrollees who can work are employed, many will lose eligibility due to lack of knowledge of requirements, paperwork burden, and administrative snafus by states. #workrequirements #states #medicaid #obbba https://www.healthcaredive.com/news/over-half-medicaid-enrollees-unaware-work-requirements-health-management-academy-survey/822228 TrumpRx Adds Drugs President Trump announced that over 100 prescription medications would be added to his administration’s direct-to-consumer drug platform, TrumpRx. #trumprx #drugpricing https://thehill.com/policy/healthcare/5913129-donald-trump-trumprx-expansion-160-drugs — Marc S. Ryan

Cities and County Sue Over Exchange Rule A group of cities and a county are suing the Trump administration over the just-finalized Affordable Care Act (ACA) Exchange rule for 2027. The parties argue that elements of the regulation — such as multi-year catastrophic plans, higher out-of-pocket caps and non-network plans as qualified health plans — are unlawful. The lawsuits say they should not be implemented. (Article may require a subscription.) #exchanges #aca #obamacare https://www.modernhealthcare.com/politics-regulation/mh-hhs-lawsuit-aca-exchange-rule-2027 KFF Covers 2026 MA Enrollment And Benefits Healthcare policy group KFF has a number of briefers on Medicare Advantage (MA) enrollment and benefits. Some key highlights across the three briefers: Additional articles:  https://www.kff.org/medicare/medicare-advantage-in-2026-enrollment-update-and-key-trends/ and https://www.kff.org/medicare/medicare-advantage-out-of-pocket-limits-variation-and-trends/ #medicareadvantage https://www.kff.org/medicare/medicare-advantage-in-2026-premiums-out-of-pocket-limits-supplemental-benefits-and-prior-authorization/ Clover MA Star Lawsuit Fallout A good Modern Healthcare article on the uncertainty created by a federal court ruling throwing out Clover Health’s 2026 Star Ratings. Cover challenged on the grounds that the Centers for Medicare and Medicaid Services