Stars Drama Begins Early
The Centers for Medicare and Medicaid Services (CMS) will release SY 2026 results in October but appears to have botched part of the rollout. In Plan Preview 2, the agency provided insurers with a private preview of their individual ratings but may have accidentally disclosed every company’s preliminary ratings in the file. It is unknown if every plan got the ultimate sneak peek or not. CMS promptly pulled the electronic data, told plans to delete any download, and reuploaded just what it should have for each plan. It also has instructed plans not to make Stars public before October’s announcement after some did so. This led to some plans seeing increases in stock, while others who did not comment saw their stocks fall.
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#stars #quality #medicareadvantage
Optum Increases Comp For Independent Pharmacies
Optum Rx, one of the big 3 pharmacy benefit managers (PBMs), has increased reimbursement minimums for brand drugs for approximately 2,300 independent pharmacies. Pharmacies have long complained that brand reimbursement is insufficient for a profit. In part the changes are in response to regulatory scrutiny and slipping market share.
#drugpricing #branddrugs #pharmacies
Reps Reject Dems’ Budget Demands
Republican leaders in the House and Senate rejected Democrats’ demands for Exchange subsidy extensions in a bill to keep government open after September 30. The GOP needs at least 7 Democratic votes in the Senate to pass the measure. This opens the prospect that Dems will hold their ground to vote against the bill and the government will shut down. The GOP bill would generally fund agencies at current levels, with a few limited exceptions.
#governmentshutdown #congress #cr
https://www.medpagetoday.com/washington-watch/washington-watch/117516
— Marc S. Ryan
