Dems Want Medicare Drug Negotiations Expanded
Democrats in the House have introduced a new bill that would expand Medicare’s ability to negotiate drug prices. The Lowering Drug Costs for American Families Act would allow Medicare to negotiate prices for more drugs each year, moving from 20 to 50, and make them applicable to the commercial market.
#drugpricing #ira #branddrugmakers #medicare #partd #commercial #employercoverage
Hospitals See Claim Denials Increase
MDaudit has found that average amounts of hospital’s denied inpatient and outpatient claims have increased by 12% and 14%, respectively. In addition, there has been an increase in payer’s audits. MDaudit looked at the first three quarters of 2025 data from its network of more than 1.2 million providers and 4,500 facilities.
#healthplans #hospitals #claimsdenials
PBM Reform Expected To Move
Senate Finance Chair Mike Crapo, R-ID, and Ranking Member Ron Wyden, D-OR, plan to reintroduce a bipartisan package regarding pharmacy benefits manager (PBM) reform. The legislation almost passed last year. Among the reforms would be flat, transparent administrative fees between plans and PBMs in Medicare as well as 100% pass-through of PBM rebates to plans. Spread pricing would be banned as well in Medicaid. Transparency reporting would also be required.
#pbms #healthplans #medicare #partd #medicaid #drugpricing
https://www.healthcaredive.com/news/crapo-wyden-to-reintroduce-bipartisan-pbm-package/806012
KHN Finds Little Provider Network Oversight At CMS
Kaiser Health News (KHN) has found via a Freedom of Information Act (FOIA) request covering the past decade, that the Centers for Medicare & Medicaid Services may have contacted just five insurers from 2016 to 2022 after seven plans failed to meet provider network adequacy requirements.
#khn #healthplans #networks #providers
M3P From IRA Expensive And Little Used
Milliman finds that just 0.6% of Medicare Part D recipients have enrolled in the Medicare Prescription Payment Plan (M3P). About 0.9% of non-low-income subsidy Medicare Part D beneficiaries, and 6.7% of non-low-income subsidy Medicare Part D beneficiaries who filled a specialty drug in 2025.
#ira #partd #medicare #drugpricing
— Marc S. Ryan
