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This would be more challenging for drugs in Medicare since the government has more price control mechanisms at its disposal via the Inflation Reduction Act. Drugmakers would be wise to increase US manufacturing in the event of a high tariff rate, though this comes with other cost considerations, including substantial upfront investments.

Ozempic, Wegovy, and Rybelsus are up for round two of Medicare drug price negotiations. Negotiated prices wouldn鈥檛 take effect until 2027 but would have a negative effect on sales for Novo鈥檚 three semaglutide GLP-1 products after that point. Yes, but: Novo acknowledged in a statement that its sales, profits, and share price have nearly tripled under J酶rgensen over the last eight years.

Comparatively, far fewer people have an unfavorable impression of hospitals (28%), doctors (16%), or Medicare (18%). Yes, and: Negative perceptions of pharma and insurance boil down to consumers鈥� belief that both stakeholders are driving up healthcare prices in the US. 蘑菇AV 75% of consumers think both stakeholders are either fairly or very responsible for the problem of high healthcare prices.

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.

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.

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.

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.

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.

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.

CVS-Oak Street rumored deal is a Medicare Advantage play: The retailer could soon be placing a big bet on value-based primary care. Is it enough to match its healthcare rivals?

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.

The Centers for Medicare & Medicaid Services under the Biden administration took enforcement against just 18 hospitals between June 2022 and January 2025, per government data. Monetary fines were levied in most of those cases. Why it matters: The order cites one projection that consumers, employers, and insurers would have saved $80 billion if the first administration鈥檚 rules were fully implemented.

Between 2022 and 2023, medical claim denials soared 20.2% on average for commercial plans and 55.7% for Medicare Advantage plans, per the American Hospital Association (AHA). Recent lawsuits filed against UnitedHealthcare, Cigna, and Humana allege that AI systems are to blame, erroneously rejecting claims at elevated rates with little or no human intervention. Predictions.

Talkspace pushed into the Medicare market last year and will prioritize marketing more to seniors in 2025. Meanwhile, its consumer revenues declined about 30% YoY. Another potential driver Talkspace pointed out is its partnership with Amazon Health Services to help consumers discover digital mental health benefits offered through their health insurer or employer.

GLP-1 drug manufacturers should brace for the reality that weight loss medications won鈥檛 be cleared for Medicare coverage. The Biden administration proposed regulation that would require Medicare (which is currently prohibited by law from doing this) and Medicaid to cover GLP-1s for weight loss.

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.

The order also instructs the HHS to consider cutting off Medicare and Medicaid reimbursement for hospitals that don鈥檛 oblige. Hospitals in locations including Colorado, Virginia, and Washington, DC have paused such care while administrators evaluate the order.

Why it matters: Kennedy is only one full Senate vote away from heading the HHS, where he would be tasked with overseeing the federal public health system, Medicare and Medicaid policy, national healthcare research money, and food and drug regulation. There is little standing in the way of Kennedy鈥檚 ascension to the HHS鈥� top spot.

Its efforts have been focused on the Centers for Medicare and Medicaid Services (CMS), whose offices DOGE representatives have been on site at this week, per The Wall Street Journal. The representatives have gained access to key payment and contracting systems and are examining the spending that flows through them for signs of what they consider to be fraud.

The Healthcare Distribution Alliance warned that the US will likely see new and worsened drug shortages and that costs will be passed down to payers and patients, including those in Medicare and Medicaid.