蘑菇AV

Medicare and Medicaid won鈥檛 have to cover GLP-1s for weight loss: The Trump administration rejected a proposal that would have improved access to the drugs for millions of Americans. The consequences will be greater for patients than for Big Pharma.

Senate confirms Dr. Oz to lead CMS: Reducing Medicare Advantage overpayments could be a priority for Oz and his team. Looming cuts to Medicaid will be tougher to justify.

Healthcare stakeholders push Congress to make Medicare coverage of telehealth permanent: It鈥檚 set to expire at the end of March. We explore what鈥檚 at stake for seniors, many of whom are used to getting care remotely.

Trump considers reviving a proposal that cuts US drug prices to international levels: It could be another blow to the drug industry, on top of ongoing drug price cuts in Medicare and looming tariffs set to hit the sector.

Health insurers鈥� digital tools lack basic capabilities: Medicare Advantage insurers must improve the digital experience since members can switch plans each year.

DOJ will examine UnitedHealth鈥檚 Medicare billing practices: The Trump administration has made 鈥渨aste, fraud, and abuse鈥� a rallying cry. Now, we find out how serious they are about it.

CMS unveils list of drugs for the next round of Medicare price negotiations: Drugmakers鈥� efforts to win over the Trump administration could amend the process in their favor鈥攗p to a certain point.

Drugmakers will push Trump to delay Medicare price negotiations: We believe the drug price negotiation program is well-intended given how much Medicare and US consumers pay for certain medications. While a program reversal is unlikely, we鈥檒l find out soon what the Trump administration thinks.

Ozempic is becoming cheaper for Medicare beneficiaries: Falling prices are welcome news for seniors鈥� wallets. But a new proposal to expand access to GLP-1s for Medicare members could threaten the federal health insurance program itself.

CMS must recalculate UnitedHealthcare鈥檚 Medicare Advantage star ratings: The ruling could be a good omen for Medicare Advantage insurers whose ratings were downgraded.

CMS must recalculate UnitedHealthcare鈥檚 Medicare Advantage star ratings: The ruling could be a good omen for Medicare Advantage insurers whose ratings were downgraded.

Trump taps Dr. Oz to helm the CMS: We detail what the celebrity doctor鈥檚 appointment would mean for the future of Medicare, Medicaid, the Affordable Care Act, and consumers enrolled in these plans.

More bad news for Medicare Advantage insurers: Humana鈥檚 huge drop in star ratings is another indicator that MA plans will likely cut seniors鈥� benefits in the future.

Prescriptions for Medicare beneficiaries have grown the most over the last five years, up 25%, and nearly triple the growth in the number of program enrollees. Prescriptions per Medicare enrollee reached 36 in 2024, also a new high. Related, we forecast Medicare prescription drug spending to eclipse $343 billion this year, up 34% from 2021.

For context, the Inflation Reduction Act (IRA) passed under the Biden administration in 2022 gives Medicare the authority to negotiate prices for high-expenditure drugs. The program stipulates that small molecule drugs (typically made as pills) can be subject to price cuts nine years following FDA approval.

Medicaid covers GLP-1 drugs for obesity in 14 states, per Real Chemistry, while Medicare does not cover GLP-1s use for weight loss. The Biden administration proposed Medicare and Medicaid coverage for GLP-1s in November, but insurers recently lobbied the Trump administration to drop the plan.

There鈥檚 large majority support against federal funding cuts for Social Security (84%), Medicare (79%) and Medicaid (76%). Americans also oppose federal funding cuts for infectious disease tracking (71%), university and medical center research (69%), and HIV prevention programs (65%).

Only 9% gave it an A, boosted by 41% of Medicare recipients who awarded an A or B compared to only 22% of people with commercial insurance. The bigger picture: Consumers鈥� lack of trust and general dissatisfaction with insurers follows a trend of discontent that surfaced prominently after the murder of UnitedHealthcare CEO Brian Thompson in December.

The news: New Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz advocated for greater use of AI in healthcare during his first meeting with agency staffers, per a Wired report. Oz even reportedly discussed the idea of AI avatars replacing clinicians. Oz noted that a typical doctor鈥檚 appointment costs about $100 between the insurance company and patient.

Lower Medicare Advantage (MA) star ratings鈥攚hich impact Aetna鈥檚 bonus payments from the federal government鈥攚as another headwind. How CVS plans to win over Wall Street: The company鈥檚 modest 2025 guidance suggests it won鈥檛 miss financial benchmarks like it did in 2024. The most impactful piece of the Aetna/MA turnaround will entail dropping 鈥渦nprofitable鈥� health plan members.

蘑菇AV 17% of Medicare beneficiaries travel more than 50 miles each way to see a neurologist, according to a study published in the Natural Library of Medicine. The bigger picture: Lilly doesn鈥檛 appear concerned that lawmakers are launching inquiries into drugmakers鈥� tie-ups with telehealth companies that seem designed to push patients toward treatments developed by the pharma company.

Medicare and Medicaid. Kennedy couldn鈥檛 clearly explain the difference between Medicare Parts A, B, and C. He also falsely stated that Medicaid premiums and deductibles are too high. [Note: Medicaid members don鈥檛 pay premiums or have deductibles except in rare circumstances.]. 3. Distrust of federal health agencies.

House Republicans can鈥檛 achieve the $2 trillion goal without cutting Medicaid or Medicare, the Congressional Budget Office said on Wednesday. Medicaid cuts would forfeit between half and 266% of any deficit-reduction benefits once the effects on children and adult health outcomes are factored in, according to the Economic Policy Institute.

Hinge cited further penetration in the self-insured employer, Medicare, and Medicaid markets as an opportunity to reach a few hundred million more patients. 2. Hinge has a defined proof of concept. Hesitant investors who have been watching the lack of public digital health activity will need evidence that Hinge鈥檚 offerings drive savings for customers while improving patient outcomes.