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January 22, 2025

CMS Appealing UnitedHealthcare’s 2025 Stars Win In very odd timing, the Centers for Medicare and Medicaid Services (CMS) has said it will appeal a federal judge’s order to recalculate UnitedHealthcare’s Medicare Advantage (MA) Star ratings. CMS did not state the grounds for its appeal.  Coming out of a federal judge’s decision siding with United in its suit, CMS did revise UnitedHealthcare’s and Centene’s star rating scores for 2025. UnitedHealthcare received higher ratings in 12 contracts and Centene in seven contracts. Centene’s suit closely mirrored United’s. Additional article: https://www.modernhealthcare.com/legal/cms-unitedhealth-medicare-advantage-star-ratings-appeal (Some articles may require a subscription.) #cms #stars #medicareadvantage https://www.fiercehealthcare.com/payers/cms-will-appeal-unitedhealthcares-ma-star-ratings-court-win Hospitals Had More Downgrades Than Upgrades in 2024 Credit downgrades for nonprofit hospitals outpaced upgrades in 2024, despite generally better financial performance in the industry overall. Moody’s, S&P, and Fitch collectively issued 95 downgrades and 37 upgrades in 2024, as opposed to 116 and 33 in 2023. Healthcare providers plan on another

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January 21, 2025

Some Trump Executive Orders Impact Healthcare As expected, re-minted President Donald Trump issued sweeping executive orders on day one of Trump 47 impacting almost all aspects of government. By and large, healthcare was less impacted. But here are some highlights: In other news, the brand drug industry will ask Trump to pause the second round of Medicare drug price negotiations in part due to ongoing litigation. Proponents urge Trump to continue and argue there is no basis for any pause. Last, advocates are asking Trump to avoid drastic Medicaid cuts and restructuring and targeting key moderates in the Senate in a public relations and advocacy campaign. Additional articles: https://www.healthcaredive.com/news/trump-reverses-biden-healthcare-executive-orders-withdraws-world-health-organization/737838/ and https://www.modernhealthcare.com/politics-policy/trump-medicare-drug-price-negotiations and https://www.modernhealthcare.com/politics-policy/donald-trump-joe-biden-ai-executive-order-repeal and https://www.modernhealthcare.com/politics-policy/donald-trump-world-health-organization-us-exit-reconsider and https://thehill.com/policy/healthcare/5097280-trump-who-executive-order/ and https://www.fiercehealthcare.com/regulatory/trump-pulls-us-out-who-condemned-public-health-experts and https://thehill.com/policy/healthcare/5098715-trump-executive-order-biden-prescription-drug-costs/ and https://insidehealthpolicy.com/daily-news/advocates-defend-medicaid-appeal-trump-massive-ad-campaign and https://www.statnews.com/2025/01/20/trump-executive-orders-health-care-drug-pricing-aca-covid-gender-discrimination/ (Some articles may require a subscription.) #trump #healthcare #first100days #medicaid #medicare #drugpricing #aca #obamacare #regulations #ai #who https://www.fiercehealthcare.com/regulatory/what-trumps-first-day-orders-mean-healthcare-ditched-drug-models-pauses-rules-and-hiring More On DOJ Suit Against Walgreens More

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January 17, 2025

Biden Releases Next 15 Medicare Drugs To Be Negotiated In a parting shot at the incoming Trump administration, outgoing President Biden’s administration issued the next list of 15 drugs subject to negotiations in Medicare. The list was due by February 1, so the early release is a challenge to the Trump administration not to repeal the negotiation law included in the Inflation Reduction Act (IRA). The prices on the 15 drugs would go into effect on January 1, 2027 after a process in 2025. In 2024, prices for the first 10 drugs were set and take effect on January 1, 2026. The Centers for Medicare and Medicaid Servies (CMS) says that between November 2023 and October 2024 about 5.3 million people with Medicare Part D coverage used these drugs to treat a variety of conditions, such as cancer, type 2 diabetes, and asthma. The drugs accounted for about $41 billion

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