蘑菇AV

The news: Medicare and Medicaid could cover GLP-1s for weight loss as part of a proposed five-year government experiment, according to a report in The Washington Post. Our take: The pilot, albeit not finalized, is a significant about-face from the Trump administration鈥攑articularly its top health official, Kennedy. It could be a signal that CMS Administrator Dr. Mehmet Oz is behind the plan, since he鈥檚 a bigger proponent of the meds. Still, we鈥檙e dubious about how many health plans will commit considering GLP-1s' high costs are a top concern for most insurers.

Amazon Pharmacy expands medication services for caregivers and Medicare users: Healthcare service providers and pharmacies can earn customer loyalty by appealing to often overlooked caregivers with services that make their roles easier.

UnitedHealth Group faces reported criminal investigation over Medicare billing fraud: The DOJ may have gathered enough evidence against UnitedHealth, such as allegedly giving doctors kickbacks. Other top players in the Medicare Advantage market should be worried.

UnitedHealth Group CEO Andrew Witty steps down: New leadership will aim to straighten out the company鈥檚 Medicare Advantage business to appease Wall Street. But we鈥檙e also keeping an eye on what they鈥檒l do to improve UHG鈥檚 sinking reputation.

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.

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.

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.

Last year, rising medical costs and lower Medicare Advantage-related government payouts weighed on Aetna. While CVS鈥� medical benefit ratio (how much a health plan spends on patient care relative to premiums collected) is still high at 89.9%, it came in lower than the projected ~91%. The signs for CVS are especially encouraging considering the headwinds its top competitors face.

The drug was included on the first list of Medicare-negotiated drugs under the Inflation Reduction Act in 2023. Eliquis generated $13.3 billion in global sales last year, with the US accounting for $9.6 billion, per BMS reporting. It was BMS鈥� highest revenue-generating drug. 90% of US Eliquis prescriptions are covered by commercial or Medicare insurance.

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.

The bigger picture: With an administration that鈥檚 more likely to fund programs for nutrition than anti-obesity drugs, investors and buyers are eying food-as-medicine companies in the Medicare and Medicaid market. However, the HHS鈥� focus is on big food brands and banning artificial dyes and chemicals from food and drink products.

That鈥檚 because pharma companies can generally charge what they want for their blockbuster products (outside of certain drugs under Medicare). Additionally, higher labor costs in the US compared with other countries could drive increases in manufacturers鈥� list prices.

Digging into the details: Exact was developing its own blood test, but bought the exclusive rights to rival Freenome鈥檚 test this week after disclosing data that disqualified its test for Medicare approval. Freenome鈥檚 screening is 81% sensitive for cancer and 90% correct for negative results, surpassing Medicare鈥檚 74% sensitivity requirement. Exact鈥檚 test came in at 73%.

The Centers for Medicare & Medicaid Services provided examples of patients using apps for diabetes or obesity management, or conversational AI tools to help people check symptoms and navigate care options. These apps and tools exist today, but they rarely have access to a person鈥檚 entire medical history. Why it matters: The US healthcare system is highly fragmented.

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.

Guarantee that all new drugs will be priced at most-favored nation rates for Medicare, Medicaid, and commercial health plans. Negotiate harder with 鈥渇oreign freeloader nations,鈥� which will be supported by US trade policy. But increased revenues earned abroad must be repatriated. Establish direct-to-consumer distribution models for 鈥渉igh-volume, high rebate鈥� drugs.

Nearly half (48%) of US adults who have paid for prescription medications said they are included in their insurance plan, per M3 MI鈥檚 2025 MARS Consumer Health Study. 21% purchase their drugs through a Medicare Part D plan. Far fewer patients pay for their prescriptions all on their own.