Government: Page 3

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    Humana appeals Medicare Advantage star ratings loss to 5th Circuit

    The insurer continues to try to prove that regulators acted arbitrarily in downgrading its quality scores for 2025, despite numerous setbacks in the courts to date.

    By • Dec. 1, 2025
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    CMS proposes overhauling Medicare Advantage star ratings

    The agency suggested cutting a dozen quality measures where health plan performance is high and beneficiaries can’t easily distinguish between offerings.

    By • Nov. 26, 2025
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    OIG report finds Medicare overpaying for CGMs and supplies

    The CMS could use its competitive bidding program to address price concerns after payments for the continuous glucose monitors swelled over five years, the government watchdog said.

    By Elise Reuter • Nov. 26, 2025
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    Lawmakers propose Medicare reimbursement pathway for AI devices

    The legislation is intended to ensure AI-enabled devices receive an accurate CMS payment code.

    By Nick Paul Taylor • Nov. 26, 2025
  • Two prescription drug cartons stand side by side on a counter, each bearing the word Wegovy.
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    CMS sets 2027 Medicare prices for Wegovy, Trelegy and 13 other drugs

    The second round of negotiations cuts spending an aggregate 44% over 2024 list prices as the federal government extends restraints over more medicines.

    By Jonathan Gardner • Nov. 26, 2025
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    HHS brings back workers fired during shutdown

    HHS reinstated all 954 workers let go last month, but firing and rehiring employees is becoming a troubling trend at the agency.

    By Susanna Vogel • Nov. 26, 2025
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    Trump administration appeals decision vacating Medicare Advantage audit rule

    A federal judge struck down the rule that would have clawed back billions of dollars in overpayments in September. Now, the HHS wants to take the case to the Fifth Circuit Court of Appeals.

    By • Nov. 25, 2025
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    CMS finalizes 2.6% outpatient pay bump, site-neutral policies

    Hospitals lambasted the final rule as inadequate, arguing the sector is facing significant financial pressures.

    By • Nov. 24, 2025
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    Oracle Health designated QHIN under TEFCA data sharing framework

    Eleven data exchanges have now received Qualified Health Information Network status, more than double the number that were recognized when the federal government’s framework first went live in late 2023.

    By • Nov. 21, 2025
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    Crapo, Wyden to reintroduce bipartisan PBM package

    Republicans and Democrats couldn’t be further apart on how to address the looming ACA affordability cliff. But there seems to be a path forward on curbing pharmacy benefit managers.

    By • Nov. 20, 2025
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    Urban safety-net hospitals vulnerable to Medicaid cuts: analysis

    Though the impact on rural facilities has received more focus from lawmakers, the majority of hospitals that are most susceptible to the funding cuts operate in urban communities, according to the report.

    By • Nov. 19, 2025
  • The U.S. Capitol stands in the distance as morning traffic moves along North Capitol Street Northwest on October 01, 2025 in Washington, DC. The government shut down early Wednesday after Congress failed to reach a funding deal.
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    Republican antipathy during key Senate hearing darkens outlook for ACA subsidy extension

    More generous subsidies for Affordable Care Act plans have helped millions of Americans afford insurance. Chances are becoming slimmer that the assistance will survive the year.

    By • Nov. 19, 2025
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    States project flat Medicaid enrollment, increased spending as cuts loom: KFF

    Total spending in the safety-net insurance program is expected to grow 7.9% in fiscal year 2026, according to the survey. Meanwhile, states are facing significant federal cuts in the wake of the One Big Beautiful Bill Act.

    By • Nov. 18, 2025
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    CMS issues guidance on Medicaid provider tax overhaul

    The agency has started to lay out how it’ll implement restrictions on the arrangements, which are used by states to finance their share of Medicaid funding, enacted in the One Big Beautiful Bill Act.

    By • Nov. 17, 2025
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    Medicare premiums set to rise 10% next year, CMS says

    The Part B premium hike could have been worse, the Trump administration said. Still, it’s likely to pressure the pocketbooks of millions of seniors, and could drive more into Medicare Advantage plans.

    By • Nov. 17, 2025
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    Telehealth flexibilities reinstated as government shutdown ends

    The pandemic-era virtual care policies are back in place through Jan. 30. But short-term deals aren’t sustainable, telehealth advocates and providers say.

    By • Nov. 13, 2025
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    Historic government shutdown ends, leaving ACA subsidies in limbo

    The House passed a stopgap funding bill and President Donald Trump signed it after a weeks-long impasse, reopening the government without a clear path forward on preserving enhanced subsidies for ACA plans — Democrats’ chief demand.

    By • Nov. 13, 2025
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    Richard Pazdur, longtime FDA oncology leader, to head agency’s main drug office

    The appointment of Pazdur as CDER head comes shortly after the surprise ousting of George Tidmarsh and should quiet many of the “lingering uncertainties” surrounding the FDA, wrote one industry analyst.

    By Kristin Jensen • Nov. 12, 2025
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    FDA to remove safety warnings on hormonal menopause therapy

    The decision, issued without the input of an official advisory committee, revises long-held labeling on the drugs cautioning the risk of cancer and heart disease.

    By • Nov. 10, 2025
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    Indiana approves controversial hospital merger despite FTC protests

    Union Hospital and Terre Haute Regional are set to merge after getting the green light from Indiana’s health department over the objections of federal regulators in two administrations and the state’s own attorney general.

    By • Nov. 10, 2025
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    Democrats introduce bill to repeal Medicare prior authorization pilot

    Lawmakers argue the CMS innovation center pilot, which will implement AI-backed prior authorization for some services in six states, will add red tape and limit access to care.

    By • Nov. 10, 2025
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    Congress inches towards ending shutdown with no extension of ACA subsidies

    The Senate overcame a key procedural hurdle on Sunday after eight Democrats broke with their party to back a measure freeing the government from the longest funding lapse in history.

    By • Nov. 10, 2025
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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 • Nov. 7, 2025
  • David Ricks, CEO of Eli Lilly, speaks alongside U.S. President Donald Trump, administration officials and fellow pharmaceutical executives on November 06, 2025 in Washington, DC.
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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 • Nov. 6, 2025