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CMMI to launch model to lower Medicaid drug spending
Under the model, set to start next year, the CMS will negotiate lower prices for Medicaid programs linked to those paid in select other countries.
By Emily Olsen • Nov. 7, 2025 -
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Novo, Lilly cut deal with Trump to lower prices of obesity drugs
The agreement will make Wegovy and Zepbound available to some Medicare enrollees for $245 per month, and starter doses of pill versions, once approved, for $149 monthly.
By Jonathan Gardner • Nov. 6, 2025 -
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Telehealth groups urge Congress to adopt long-term virtual care fix
More than 450 telehealth and provider organizations are pushing lawmakers to avoid another temporary extension of telemedicine flexibilities amid a historic government shutdown.
By Emily Olsen • Nov. 6, 2025 -
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Legislators object to proposed CMS payment changes for diabetes tech
In a letter to CMS Administrator Dr. Mehmet Oz, diabetes caucus leaders raised concerns that the agency’s proposals will reduce access to glucose monitors and insulin pumps.
By Elise Reuter • Nov. 4, 2025 -
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Health groups urge passage of bill to ease Medicare pay cuts for tests
More than 30 organizations, including AdvaMed and the American Clinical Laboratory Association, are pushing for a permanent legislative solution to stop looming Medicare payment cuts for diagnostic tests.
By Susan Kelly • Nov. 3, 2025 -
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Medicare finalizes controversial cut to specialty care next year
The CMS finalized the Medicare physician fee schedule for 2026 on Friday, one day before the statutory deadline. It includes an overall payment hike and a few policies that are deeply unpopular with specialists.
By Rebecca Pifer • Updated Nov. 4, 2025 -
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Federal ACA enrollment kicks off without action on subsidies
Millions of Americans are facing steep price hikes for Affordable Care Act coverage while Congress dithers over the issue. Experts say there’s not as much time to act as legislators may believe.
By Rebecca Pifer • Nov. 1, 2025 -
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OpinionNew CBO report confirms 340B’s ballooning costs. Congress must act.
Former Congressional Budget Office Director Dan Crippen argues the 340B discount program is overdue for reform.
By Dan Crippen • Oct. 31, 2025 -
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HRSA approves 340B rebate models to hospitals’ chagrin
Drugs that will be subject to rebates in 340B next year include Bristol Myers Squibb’s Eliquis, Johnson & Johnson’s Stelara and Novo Nordisk’s Novolog.
By Rebecca Pifer • Oct. 31, 2025 -
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FDA, aiming to lower drug costs, moves to speed approval of biosimilars
The agency will no longer require studies comparing copycat biologics to their branded counterparts, which could help developers bring them to market more quickly and cheaply.
By Jonathan Gardner • Oct. 29, 2025 -
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Senators show bipartisan support for reforming 340B during HELP hearing
Lawmakers called for more transparency about how hospitals are using 340B revenue, including audits of participating facilities.
By Susanna Vogel • Oct. 24, 2025 -
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CMS calls back furloughed employees to help with Medicare, ACA enrollment periods
Roughly 3,000 employees went back to work on Monday, funded by user fees as the shutdown drags into its fourth week.
By Rebecca Pifer • Oct. 24, 2025 -
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HLTH25Top RFK aide lashes out against healthcare industry for profiting off of illness
Calley Means stopped short of accusing hospitals, insurers and drug companies of actively working to keep Americans sick, but said it was an "economic fact" that the companies benefit financially when people are ill.
By Susanna Vogel • Oct. 22, 2025 -
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AHA urges tariff exceptions for certain PPE, medical devices
The American Hospital Association warned future tariffs arising from the Trump administration’s Section 232 investigation could disrupt access to an array of tools and personal protective equipment.
By Susan Kelly • Oct. 21, 2025 -
Susanna Vogel/Healthcare Dive
HLTH25Mark Cuban says Cost Plus Drugs will partner with TrumpRx
Cost Plus Drugs is sharing pricing data with TrumpRx, the administration’s new direct-to-consumer prescription drug website set to launch next year.
By Susanna Vogel • Oct. 20, 2025 -
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HHS says it can still fire workers despite judge’s order pausing shutdown layoffs
The 982 HHS employees who received reduction-in-force notices are not represented by the unions that are plaintiffs in the case, the department’s head of personnel argued in a court filing.
By Rebecca Pifer • Oct. 20, 2025 -
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CMS slows technical support for rural health fund despite looming deadline
States have just weeks to submit their applications for the new Rural Health Transformation Program, but the CMS says its ability to provide support may be delayed due to the government shutdown.
By Susanna Vogel • Oct. 17, 2025 -
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Oz reiterates need to improve Medicare Advantage payment accuracy
The CMS administrator’s comments at an industry event in D.C. reflect the difficult tightrope regulators in the Trump administration walk as they pursue MA reform.
By Rebecca Pifer • Oct. 15, 2025 -
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California passes laws targeting PBMs, private equity
Gov. Gavin Newsom signed an array of healthcare bills into law last week that crack down on pharmacy benefit managers and beef up the review process for deals involving private equity firms.
By Susanna Vogel • Oct. 15, 2025 -
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Senate Finance Committee probes Medicaid contractors over faulty systems
Top Democrats are airing related concerns that the IT chassis underpinning states’ Medicaid operations may not be robust enough to withstand the added pressure from looming work requirements.
By Rebecca Pifer • Oct. 15, 2025 -
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Humana loses Medicare Advantage stars lawsuit for a second time
A federal judge ruled in favor of the CMS on Tuesday, one day before the start of Medicare open enrollment. A spokesperson for Humana said the insurer is considering “all available legal options.”
By Rebecca Pifer • Oct. 14, 2025 -
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Top Democrat questions Medicare Advantage insurers on AI claims denials
The letter from Sen. Richard Blumenthal comes one year after a Senate investigation criticized major MA payers for using predictive technology to deny post-acute care.
By Emily Olsen • Oct. 14, 2025 -
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Trump administration moves to fire HHS employees amid shutdown
Upwards of 1,000 HHS employees were affected. However, the department has rolled back some of the layoffs at the CDC, where the brunt of the terminations were concentrated.
By Rebecca Pifer • Updated Oct. 14, 2025 -
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Winners and losers from 2026 Medicare Advantage star ratings
The CMS quietly released anticipated star ratings data Thursday night. Humana and Aetna saw enrollment in highly rated plans fall, while Elevance’s and Centene’s stars improved and UnitedHealthcare’s stayed stable.
By Rebecca Pifer • Oct. 10, 2025 -
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California is the latest state to enact tougher restrictions on private equity in healthcare
The new law prohibits financial firms from having a hand in medical decisions, including determining how many patients clinicians see per hour or what diagnostic tests are appropriate.
By Susanna Vogel • Oct. 10, 2025
