Policy Digest — March 9, 2026

Introduction

This week, Medicaid dominated the policy agenda as new analyses put a $664 billion price tag on federal spending reductions and states began grappling with implementation costs under the One Big Beautiful Bill Act. At FDA, Vinay Prasad's second departure raised fresh questions about Commissioner Makary's leadership and the agency's regulatory direction. And an AI buildout continued across payers, providers, and federal agencies—including a high-profile ban on Anthropic's Claude at HHS.

Weekly Spotlight

This week, the financial and operational reality of the One Big Beautiful Bill Act’s Medicaid overhaul came into sharper focus across multiple fronts, with new analyses quantifying the scale of federal reductions and states beginning to navigate the implementation complexity ahead.

The headline number came from a RAND Corporation analysis projecting $664 billion in federal Medicaid reductions through 2034, with 20 states facing cuts of 5% or more. Those cuts will fall unevenly: states that expanded Medicaid under the Affordable Care Act face steeper exposure, and the analysis underscores what many state health officials have said privately that federal reductions will force states to choose between raising taxes, cutting other programs, or rolling back coverage. The Congressional Budget Office projects 6 million fewer insured Americans as a result of the law’s Medicaid provisions.

The fiscal picture is not simply about what states lose—it is also about what they must spend. States must implement new work requirements and six-month eligibility redeterminations beginning January 1, 2027, and an AP analysis of more than 25 state budget projections found implementation costs will far exceed the $200 million federal allotment, with total costs likely exceeding $1 billion. Georgia—the only state with an active work requirement—spent $54 million in administrative costs from 2021 through early 2025, more than twice the amount paid out in actual medical assistance over the same period.

CMS moved on multiple fronts this week to set the implementation framework. A March 6 guidance letter gave states two options for transitioning to six-month eligibility checks: an immediate full transition that critics warn could overwhelm state systems with a surge of renewals in January 2027, or a rolling transition that switches each beneficiary after their next scheduled annual renewal. A separate proposed rule now under OMB review would cap state directed payments for expansion states at 100% of Medicare, with hints that CMS may expand the cap list beyond what the law requires.

The human dimension was illustrated in a KFF Health News investigation profiling Iowa families facing cuts to Medicaid home and community-based services waivers, which help people with disabilities live independently. One family was notified of a 40% reduction in caregiving hours for their adult son with severe autism. More than 600,000 Americans were already on HCBS waiting lists in 2025, and disability rights groups in Colorado, Missouri, Nebraska, and Idaho have also reported proposed cuts. Institutional placement costs roughly twice as much as home-based care—meaning HCBS cuts may ultimately cost more.

The combined picture is of a program under simultaneous pressure: federal spending caps, eligibility tightening, work mandates, payment rule changes, and fraud scrutiny—all arriving as states face tight budgets and federal implementation support falls short.

Tags: #PATIENT #PAYER #PROVIDER #HOSPITAL

Centers for Medicare and Medicaid Services (CMS)

MA Insurers Warn of Consequences from Flat 2027 Payment Proposal

Medicare Advantage insurers are warning that CMS’s proposal to hold federal payments virtually flat for 2027 will harm the program and its beneficiaries. The pushback comes as a Health Affairs study found that CMS’s new risk-adjustment model, implemented in 2024, had limited impact on MA benefits between 2024 and 2025, undercutting prior industry claims that the model change would force significant benefit cuts.
Source(s):
Insurers issue dire warnings about Medicare Advantage pay rule
CMS’s New Risk-Adjustment Model Had Limited Impact On Medicare Advantage Benefits, 2024-25
Tags: #PAYER #PATIENT #PROVIDER

Medicaid Roundup

States are confronting the financial and operational scope of Medicaid changes under the One Big Beautiful Bill Act, with new federal guidance, analyses, and on-the-ground reporting illuminating the stakes.

CMS Gives States Two Options to Transition to Six-Month Medicaid Eligibility Checks
CMS’ Proposed State Directed Payment Rule Under Review At OMB
A Look at the Intersection of SNAP and Medicaid as States Implement Medicaid Work Requirements
CMS releases Medicaid billing data to expand fraud oversight
A RAND analysis projects $664 billion in federal Medicaid reductions through 2034, with 20 states facing cuts of 5% or more. Implementation costs for work requirements and six-month eligibility checks will exceed $1 billion, far outstripping the $200 million federal allotment; the CBO projects 6 million fewer insured Americans as a result. Sources: State Medicaid budgets to weather $664B reduction through 2034 due to OBBBA: RAND, State Medicaid budgets face $664B cut due to Big Beautiful Bill: study, Medicaid Work Mandates Are Meant to Save $$, but States Have to Spend Millions First
KFF Health News profiled Iowa families facing 40% reductions in Medicaid home and community-based services (HCBS) hours for family members with disabilities. More than 600,000 Americans were on HCBS waiting lists in 2025; disability rights groups in four additional states have reported proposed cuts. Institutional placement costs roughly twice as much as home-based care. Sources: Trump’s Cuts to Medicaid Threaten Services That Help Disabled People Live at Home

Tags: #PATIENT #PAYER #PROVIDER

States Embrace Rural Health Transformation Fund, But Implementation Battles Loom

Forty-two states are expanding or establishing alternative payment models to compete for a share of the $50 billion Rural Health Transformation Program fund, signaling broad state momentum toward value-based care, according to a USofCare report. However, Republican state lawmakers and hospital associations are pushing back against some federally pre-approved spending plans, with at least one GOP legislative group scuttling an approved initiative and at least one hospital association successfully altering spending oversight.
Source(s):
Report: Most states investing in value-based care with Rural Health Transformation Program
Lawmakers, Health Groups Resist Their States’ Rural Health Fund Plans
Tags: #PROVIDER #HOSPITAL #PATIENT

Value-Based Care Payment Models Roundup

CMS continued its push to expand mandatory and AI-powered payment models this week, with new details on several major programs.

Hospitals can use 2026 to prepare for CMS TEAM bundled payment risk
Prospective ACCESS Applicants See AI, Waiving Coinsurance As Keys To Success
Did you make the list? CMS targets cardiologists for new heart failure payment model
CMMI Director Abe Sutton confirmed mandatory models will be central to value-based care expansion, noting CMS proposed three mandatory models in 2025—the highest in a single year. CMS Administrator Mehmet Oz said the agency aims to draw lower-quality providers into accountable care; only four of roughly 50 CMMI models have been selected for expansion to date. Sources: CMS innovation center remains focused on mandatory models, officials say
Remote patient monitoring company Cadence announced it will participate in CMMI’s ACCESS model, restructuring its service around AI agents with human clinician oversight to make the $180-$420 per patient annual payment viable. Sources: Health tech company says it will dive into Medicare’s new chronic care experiment

Tags: #PROVIDER #PAYER #HOSPITAL

Doctors’ Mistrust of Insurers Is Holding Up Instant Prior Authorization, Dr. Oz Says

CMS Administrator Mehmet Oz said physicians’ distrust of insurers is a key reason real-time prior authorization has not materialized, noting that doctors refuse to share data and prefer paper responses, blocking the digital exchange needed for instantaneous authorization.
Source(s): Doctors’ Mistrust of Insurers Is Holding Up Instant Prior Authorization, Dr. Oz Says
Tags: #PROVIDER #PAYER

Clover Health Becomes First Healthcare Payer to Meet CMS Interoperability Standard

Clover Health became the first payer to qualify as a CMS Aligned Network, enabling real-time medical record sharing for its Medicare Advantage patients through secure data exchange via Kno2.
Source(s): Clover Health becomes first healthcare payer to meet CMS interoperability standard
Tags: #PAYER #PROVIDER

Billing and Coding Roundup

A cluster of billing and coding developments this week signals growing insurer scrutiny of documentation practices and a long-overdue overhaul of maternity billing.

Tags: #PAYER #PROVIDER #HOSPITAL

Food and Drug Administration (FDA)

Vinay Prasad Exits FDA Again, Raising Questions About Commissioner Makary’s Leadership

FDA biologics chief Vinay Prasad will depart the agency at the end of April—his second exit after being fired last July and rehired weeks later—following renewed controversy over a series of rare disease drug rejections and an anonymous press call in which he allegedly disclosed trade secrets about UniQure’s Huntington’s disease gene therapy. Commissioner Marty Makary framed the departure as a planned return to Prasad’s academic post at UCSF, but critics including Rep. Jake Auchincloss (D-MA) called it a failure of Makary’s leadership and demanded congressional hearings. Prasad’s tenure also coincided with a 72% decline in FDA advisory committee meetings, raising concerns about transparency; staff say scientists rarely pitch holding adcomms anymore due to limited resources and lack of leadership interest. The choice of Prasad’s successor at the Center for Biologics Evaluation and Research is now seen as a make-or-break decision for Makary’s commissionership.
Source(s):
FDA’s Vinay Prasad to depart agency at the end of April
Prasad Out At FDA, Turning Critics’ Focus Back To Makary
FDA’s Controversial Vaccine Chief Exits … Again
Divisive F.D.A. Vaccine Regulator Is Resigning
As controversial decisions mount, FDA shuns public advisory meetings
Tags: #ALL

FDA Faces Pushback Over Rare Disease Drug Denials

FDA officials are promising fast reviews of new treatments while insisting they will not rubber-stamp industry submissions, but patients with rare diseases see recent denials as signs that the doors are closing on their options. STAT reports that the approaches of FDA leaders including Vinay Prasad and Peter Marks have come at costs to regulatory frameworks, with investors pulling back from rare disease investment.
Source(s):
F.D.A. Faces Upset Over Denials of New Drugs
The extremism of the FDA’s Marks and Prasad has come with costs
Tags: #DRUG #PATIENT

FDA Takes Further Steps to Streamline Biosimilar Development and Make Medicines More Affordable

FDA issued new draft guidance on March 9 recommending that biosimilar developers streamline clinical pharmacokinetic testing when scientifically justified, a change the agency estimates could reduce study costs by up to 50%, or approximately $20 million per application. The guidance also allows applicants to use clinical data from non-U.S.-licensed comparator products without an additional three-way study in certain circumstances. FDA Commissioner Marty Makary framed the move as part of an ongoing effort to lower drug costs, noting that biologics account for 51% of drug spending despite comprising only 5% of prescriptions.
Source(s): FDA Takes Further Steps to Streamline Biosimilar Development and Make Medicines More Affordable
Tags: #DRUG #PAYER #PATIENT

FDA Grants ‘Breakthrough’ Status to Generative AI Chatbot for Surgical Patients

The FDA granted breakthrough device designation to RecovryAI, a generative AI chatbot for patients recovering from surgery. The decision is notable as a signal of how the agency may regulate generative AI tools, following Commissioner Makary’s January announcement that FDA is developing a new regulatory framework for AI.
Source(s): FDA grants ‘breakthrough’ status to generative AI chatbot for surgical patients
Tags: #DEVICE #PROVIDER #PATIENT

Estrogen Patches Harder to Find as FDA Pushes Hormone Therapy

Estrogen patches are becoming harder to find after HHS Secretary Robert F. Kennedy Jr. announced in November that the FDA was lifting the black box warning from hormone replacement therapy products for menopause, generating unprecedented demand. All five patch manufacturers are producing at full capacity. HHS says it is working with manufacturers to ensure supply meets demand.
Source(s): Estrogen patches harder to find as FDA pushes hormone therapy
Tags: #PATIENT #DRUG #PROVIDER

A New Once-Daily HIV Pill Holds Promise for HIV’s ‘Forgotten Population’

Gilead has announced a new once-daily HIV pill designed for patients unable to take other single-tablet regimens who are currently on complex multi-drug schedules. The drug addresses what NPR calls HIV’s ‘forgotten population’ and offers a simplified treatment option as the virus continues to evolve.
Source(s): A new one-a-day-pill holds promise for HIV’s ‘forgotten population’
Tags: #DRUG #PATIENT #PROVIDER

How the ‘Holy Grail’ Weight Loss Pill Became a Reality, and What Comes Next

The era of oral GLP-1 weight loss drugs has arrived. Novo Nordisk has released an oral version of Wegovy, and Eli Lilly’s oral GLP-1 candidate orforglipron is expected to receive FDA approval as early as this month. STAT examines the pharmaceutical race to develop effective weight loss pills, the clinical and commercial stakes, and the implications for patients who preferred not to use injectable forms.
Source(s): How the ‘holy grail’ weight loss pill became a reality, and what comes next
Tags: #DRUG #PATIENT #PAYER

Abbott Wins FDA Approval for Updated Heart Failure Monitoring Device

The FDA approved Abbott’s CardioMEMS Hero, a redesigned remote heart failure monitoring reader that is 60% lighter and integrates Wi-Fi and cellular connectivity with the existing implanted CardioMEMS sensor. The launch could benefit from CMS’s 2025 national coverage determination for implantable pulmonary artery pressure sensors, and CardioMEMS contributed to 12% growth in Abbott’s heart failure franchise in Q4.
Source(s): Abbott wins FDA approval for updated heart failure monitoring device
Tags: #DEVICE #PROVIDER #PATIENT

FDA Drug Chief Aims to Hire Friend Pushing for Controversial SSRI Warning

FDA drug center head Tracy Beth Hoeg is working to hire Adam Urato, a maternal-fetal medicine specialist who has petitioned the FDA to add a boxed warning to SSRIs citing pregnancy risks. Agency staff view the relationship as a conflict of interest. Outside experts say the petition relies on flimsy data and warn a new warning could cause pregnant women to stop antidepressants unnecessarily; more than 15% of U.S. women take medication for depression.
Source(s): FDA Drug Chief Aims to Hire Friend Pushing for Controversial SSRI Warning
Tags: #DRUG #PATIENT #PROVIDER

Department of Health and Human Services (HHS)

Public Trust in Federal Health Agencies Continues to Decline Under RFK Jr.

A new Annenberg Public Policy Center survey of 1,650 adults finds that confidence in the CDC, FDA, and NIH fell another 5 to 7 percentage points over the past year. Only 43% of respondents said they trust the current leaders of HHS agencies, compared to 67% who trust career scientists. Just 38% expressed trust in HHS Secretary Robert F. Kennedy Jr. specifically. Professional medical organizations significantly outpaced government agencies on trust measures. HHS disputed the framing, noting that public trust had already declined from 72% to 40% between 2020 and 2024.
Source(s):
Poll: Career Scientists, Outside Experts Trusted More Than HHS Leaders
RFK Jr. losing battle to boost trust in public health agencies
RFK Jr. vowed to restore public trust in health. It’s not working, a new survey suggests.
Tags: #ALL

HHS Bans Claude AI Tool as Trump Administration Seeks to Blacklist Anthropic

HHS directed employees to stop using Anthropic’s Claude AI and transition to alternatives—primarily ChatGPT or Gemini–according to an internal email first reported by NOTUS. The shift could disrupt FDA’s plans to use Claude for expediting drug approvals. The directive is part of a broader Trump administration effort to blacklist Anthropic from federal government use entirely.
Source(s):
HHS bans Claude AI tool as Trump seeks full government blacklisting of Anthropic
HHS tells employees to abandon Claude AI, as Trump feuds with developer Anthropic
Tags: #ALL

HHS, Medical Schools Announce Nutrition Education Initiative

HHS Secretary Robert F. Kennedy Jr. announced that 52-53 medical schools across 31 states have voluntarily pledged to incorporate at least 40 hours of nutrition training into their four-year undergraduate medical curricula beginning this fall. Kennedy framed the initiative as central to his Make America Healthy Again agenda. Critics note that Americans’ unhealthy diets are driven more by financial and time constraints than physician knowledge gaps, though medical educators widely acknowledge the field has historically underemphasized nutrition.
Source(s):
HHS Says About 50 Medical Schools Will Add Nutrition Training To Curricula
Med Schools, HHS Announce Nutrition Education Initiative
RFK Jr. pushes medical schools to teach more about nutrition
Tags: #PROVIDER #PATIENT

States Restrict HIV Drug Access as Federal ADAP Funding Stagnates

Twenty-four states, including Washington D.C., have implemented or are considering cost-containment measures for their AIDS Drug Assistance Programs (ADAPs). Florida has taken the most dramatic steps, proposing to slash income eligibility from 400% to 130% of the federal poverty level and remove Biktarvy from its formulary. Federal ADAP appropriations have been flat at $900.3 million since FY2014, while client enrollment has risen 56% since 2007 and inflation-adjusted purchasing power has declined 31% since 2005.
Source(s):
States limiting HIV drug access as federal funding plateaus
Constrained Budgets Lead States to Restrict HIV Drug Access Through Ryan White
States Move to Limit Access to H.I.V. Treatment
Tags: #PATIENT #DRUG #PROVIDER

Acting CDC Director Bhattacharya Urges Measles Vaccines

Acting CDC Director Jay Bhattacharya urged families to vaccinate against measles as the U.S. has confirmed 1,136 cases and 10 new outbreaks in 2026. Last year was the worst for measles in decades, with nearly 2,300 cases across 50 outbreaks. The U.S. technically met the criteria to lose its measles elimination status on January 20, and the Pan American Health Organization has scheduled an April meeting to review U.S. and Mexico statuses.
Source(s): Acting CDC director Bhattacharya urges measles vaccines
Tags: #PATIENT #PROVIDER

Jay Bhattacharya Might Get His COVID Capstone

The Atlantic profiles Jay Bhattacharya, now positioned to shape federal public health policy after years as a controversial outsider. Bhattacharya co-authored the 2020 Great Barrington Declaration, which health experts widely criticized for downplaying COVID risks. The piece examines how his elevation under the Trump administration represents a potential vindication of his COVID-era positions and what that means for CDC’s scientific direction.
Source(s): Jay Bhattacharya Might Get His COVID Capstone
Tags: #ALL

USPSTF Meeting Pushed Back for Third Time in a Row

The U.S. Preventive Services Task Force has postponed its scheduled meeting for the third consecutive time. The task force has not convened since March 2025 after meetings in July and November were abruptly canceled. No new date has been scheduled.
Source(s): USPSTF Meeting Pushed Back for Third Time in a Row
Tags: #PROVIDER #PATIENT

Autism Scientists Form Independent Committee to Counter RFK Jr.

Former NIH institute directors, autism researchers, and advocacy leaders established the Independent Autism Coordinating Committee to coordinate nongovernment autism research funding and develop a scientific agenda outside of federal oversight, amid concerns about the administration’s approach to autism science.
Source(s): Autism Scientists Form Independent Committee to Counter RFK Jr.
Tags: #PATIENT #PROVIDER

Delays in Awards and Funding Calls Worry NIH-Funded Researchers

The National Institutes of Health (NIH) has delayed posting calls for new grant applications so long that large academic research programs may not have funding renewed until next fiscal year. The slowdown compounds concerns that the White House is blocking NIH from spending its congressionally approved budget before the September 30 fiscal year deadline.
Source(s): Delays in awards and funding calls worry NIH-funded researchers
Tags: #PROVIDER #PATIENT

Federal Science Exodus Roundup

Multiple outlets this week documented the ongoing departure of federal scientists and the organizing responses it has inspired.

Tags: #ALL

Heard on the Hill

Democrats Press Trump on Drug Pricing: MFN Deals and New Payment Models Under Scrutiny

Senior congressional Democrats escalated pressure on the Trump administration over two parallel drug pricing fronts this week. On most-favored-nation (MFN) deals, Democrats demanded unredacted copies of the administration’s MFN pricing agreements with 16 pharmaceutical companies, noting that SEC filings from Pfizer and Eli Lilly suggest the deals remain unfinalized. Separately, Senate Finance ranking Democrat Ron Wyden and House counterparts wrote HHS Secretary Robert F. Kennedy Jr. pressing for details on three new Medicare and Medicaid drug pricing models—GLOBE, GUARD, and GENEROUS—and warning that MFN side deals could create loopholes that undermine those initiatives.
Source(s):
Democrats Ask Trump For Copies Of MFN Deals
Democrats Seek Details On GLOBE, GUARD, GENEROUS Models, Warn Of Pharma Deal Loopholes
Tags: #DRUG #PAYER

House’s Medicaid Fraud Probe Expands to 10 States

House Energy and Commerce Committee Republicans expanded a Medicaid fraud investigation to 10 states, sending letters demanding records and communications from governors and state health agency leaders. States targeted include New York, California, Colorado, Massachusetts, Maine, Nebraska, Oregon, and Pennsylvania. The probe reflects ongoing GOP efforts to identify waste and program integrity failures ahead of potential Medicaid spending reductions in budget reconciliation.
Source(s): House’s Medicaid fraud probe expands to 10 states
Tags: #PAYER #HOSPITAL #PROVIDER

Stakeholders Still Dissatisfied With MIPS, Call For Greater CMMI Transparency In Feedback To House MACRA RFI

Stakeholder responses to a House physician caucus request for information on modernizing the Medicare Access and CHIP Reauthorization Act (MACRA) reflect continued dissatisfaction with the Merit-based Incentive Payment System (MIPS), which respondents say is falling short of its goals. A second prominent theme is a call for greater transparency at the CMS Innovation Center. The feedback was summarized at the Accountable for Health conference.
Source(s): Stakeholders Still Dissatisfied With MIPS, Call For Greater CMMI Transparency In Feedback To House MACRA RFI
Tags: #PROVIDER #HOSPITAL

It Took Years for Congress to Enact PBM Transparency, Delinking. What About Vertical Integration?

Experts say the bipartisan Break Up Big Medicine Act, which targets vertically integrated healthcare companies including pharmacy benefit managers (PBMs), faces slim odds of passage despite the landmark PBM reforms included in the Consolidated Appropriations Act of 2026. The article examines the slow legislative trajectory of PBM regulation and whether Congress has the appetite to tackle vertical integration after years of incremental progress.
Source(s): It Took Years for Congress to Enact PBM Transparency, Delinking. What About Vertical Integration?
Tags: #PAYER #DRUG #PROVIDER

This Doctor-Senator Who Backed RFK Jr. Now Faces a Fight for His Job—And His Legacy

KFF Health News profiles Sen. Bill Cassidy (R-LA), a physician-senator who voted to confirm Robert F. Kennedy Jr. as HHS Secretary despite Kennedy’s history of vaccine skepticism—a vote that may cost Cassidy his Senate seat. Cassidy now faces a primary challenge tied in part to his confirmation vote, setting up a sharp contrast with his decades-long record championing hepatitis B vaccination in Louisiana.
Source(s): This Doctor-Senator Who Backed RFK Jr. Now Faces a Fight for His Job—And His Legacy
Tags: #ALL

SCAI Celebrates New Federal Funding for PAD Prevention

The Society for Cardiovascular Angiography and Interventions (SCAI) praised new federal funding aimed at addressing rising rates of peripheral artery disease and chronic limb-threatening ischemia in the United States.
Source(s): SCAI celebrates new federal funding for PAD prevention
Tags: #DEVICE #PROVIDER #PATIENT

Notable Notes

AI in Health Roundup

Artificial intelligence continued its rapid expansion across health care this week, spanning federal governance, clinical tools, insurance operations, and consumer-facing platforms.

ASTP, Lawmakers Broach AI, Privacy Issues Posed By Interoperability
HIPAA Was Built for an Analog Era, Healthcare AI Has Outgrown It
Fed agencies told to track AI’s impact on the workforce
Cardiology now has more than 200 FDA-cleared AI algorithms
Cardiology groups to Trump administration: AI still has a long way to go
How can HHS drive clinical AI adoption? The industry wish list is starting to take shape
One malpractice insurer on how AI will change the industry
Amazon launches suite of healthcare AI agents
CVS Health unveiled Health100, a new consumer health subsidiary built in partnership with Google Cloud that will aggregate patient data from insurers, providers, pharmacies, and connected devices to provide AI-powered care navigation, cost estimates, and proactive health guidance. CVS said the platform will adopt an open ecosystem approach, inviting competitors to participate. Sources: CVS Health to launch health tech subsidiary, AI platform, CVS unveils Health 100, its new Google-powered consumer engagement platform, CVS, Google Cloud partner on healthcare consumer engagement platform

Tags: #ALL

340B Program Roundup

The 340B Drug Pricing Program faced pressure on multiple fronts this week in the courts, from manufacturers, and in state-level data.

Tags: #HOSPITAL #DRUG #PROVIDER

Drug Pricing Roundup

Several drug pricing developments unfolded this week beyond the federal legislative front, spanning the Trump administration’s new retail platform, state affordability efforts, and employer-facing changes in the pharmacy benefit market.

Tags: #DRUG #PATIENT #PAYER

Structural Heart Disease Roundup

Structural heart disease saw a busy week of clinical innovation, outcomes data, and device advances.

World’s first polymeric TAVR valve impresses cardiologists could improve durability, reduce costs
Cardiologists develop new AI screening tool for structural heart disease
Cardiologists perform first TAVR of its kind by anchoring valve to crushed stent
A study of more than 2,200 T-TEER patients across 30 European centers found NT-proBNP levels are an independent predictor of all-cause mortality and heart failure hospitalization after tricuspid transcatheter edge-to-edge repair, with the composite endpoint occurring in 35.3% of patients over a median follow-up of 1,139 days. Sources: Heart failure biomarker identifies long-term risk in T-TEER patients

Tags: #DEVICE #PROVIDER

Eli Lilly Launches Employer Connect Platform for Zepbound

Eli Lilly officially launched Employer Connect, a direct-to-employer platform offering Zepbound at a discounted $449/month price through network pharmacies, bypassing traditional pharmacy benefit manager channels. The program partners with more than 15 independent administrators, including Teladoc Health, GoodRx, Mark Cuban Cost Plus Drugs, and 9amHealth, allowing employers to select the coverage model that fits their benefits strategy.
Source(s):
Eli Lilly launches its direct-to-employer platform for obesity drugs
Eli Lilly launches program for employers to subsidize cost of obesity drug outside insurance
Tags: #DRUG #PAYER #PATIENT

Even Patients Are Shocked by the Prices Their Insurers Will Pay—And It Costs All of Us

A KFF Health News investigation examines how chargemaster billing and opaque insurer-provider contracts drive medical costs, profiling patients billed $100,000 for an ectopic pregnancy surgery and $77,000 for a PET scan. Price transparency data reveals that different insurers pay wildly different rates for the same services at the same hospital—sometimes three or more times apart. The piece argues insurers have little incentive to negotiate lower prices because Affordable Care Act (ACA) medical loss ratio rules allow them to pass cost increases through to premiums.
Source(s): Even Patients Are Shocked by the Prices Their Insurers Will Pay—And It Costs All of Us
Tags: #PATIENT #PAYER #HOSPITAL

How Price Transparency Data Explains Aetna’s ACA Market Exit

A Serif Health analysis of Transparency in Coverage data across 16 states finds Aetna’s Exchange negotiated rates ran approximately 20% higher than peer payers, with median institutional rates at 134% of Medicare compared to 99% for Cigna and 97% for UnitedHealthcare. In-network institutional rates grew approximately 22% year-over-year for Aetna, versus roughly 8% for UnitedHealthcare—a structural disadvantage in a premium-sensitive market.
Source(s): How Price Transparency Data Explains Aetna’s ACA Market Exit
Tags: #PAYER #PATIENT

Two of the Biggest Patient-Assistance Charities Are Combining

The Patient Advocate Foundation and the Patient Access Network Foundation have merged, creating a combined entity with more than $800 million in assets that will help patients afford drug copays and navigate health insurance.
Source(s): Two of the Biggest Patient-Assistance Charities Are Combining
Tags: #PATIENT #DRUG

Hospital Prices Drive High Healthcare Costs, Economist Says

In a MedPage Today interview series asking healthcare economists about U.S. healthcare costs, Yale economist Zack Cooper identifies the growth in hospital prices as the primary driver.
Source(s): Hospital Prices Drive High Healthcare Costs, Economist Says
Tags: #HOSPITAL #PAYER #PATIENT

The Impossible Predicament of the Uninsured

An Atlantic feature recounts one family’s experience navigating the U.S. healthcare system without insurance, illustrating the ongoing access and affordability gaps that leave uninsured Americans in impossible situations—unable to afford the hospital, but ending up there anyway.
Source(s): The Impossible Predicament of the Uninsured
Tags: #PATIENT

The Doctors Are Not Alright

A MedPage Today column examines the mental and physical health crisis among U.S. healthcare workers, citing a 2024 University of Washington study of over 10 million healthcare workers that found higher rates of depression, mental illness, and chronic illness compared to the general population. Healthcare workers are five times more likely to experience workplace violence. The latest federal budget reauthorized the Lorna Breen Health Care Provider Protection Act through FY2030.
Source(s): The Doctors Are Not Alright
Tags: #PROVIDER #HOSPITAL

Why Pediatric Readiness Matters More Than Ever

An updated Pediatric Readiness in the Emergency Department Policy Statement arrives as the U.S. has lost nearly 30% of pediatric inpatient units since 2008 while losing only 4.4% of adult units. Emergency departments with high Pediatric Readiness scores are associated with an estimated 2,143 fewer child deaths per year.
Source(s): Why Pediatric Readiness Matters More Than Ever
Tags: #HOSPITAL #PROVIDER #PATIENT

Medtronic, GE HealthCare Expand Patient Monitoring Alliance

Medtronic and GE HealthCare expanded their multi-year partnership to integrate Medtronic’s pulse oximetry, brain monitoring, capnography, and regional oximetry technologies into GE HealthCare devices across bedside, telemetry, ambulatory, maternal-infant, and perioperative settings.
Source(s): Medtronic, GE HealthCare expand patient monitoring alliance
Tags: #DEVICE #PROVIDER

Guardant Hits the Road With Colon Cancer Blood Test

Guardant Health is launching a direct-to-consumer campaign to boost adoption of its Shield blood test for colorectal cancer screening, targeting the roughly 40% of Americans who are behind on recommended screenings. Shield received FDA approval in 2024 as the first blood-based colorectal cancer screening test, and CMS approved reimbursement in 2025.
Source(s): Guardant hits the road with colon cancer blood test
Tags: #PATIENT #DEVICE #PROVIDER