CMS proposed new guardrails for pharmacy benefit managers and Medicare Advantage directories, the administration tightened Affordable Care Act subsidies, and a bipartisan House bill would delay the 340B rebate pilot for two years.
Cardiologists welcomed CMS’s new TAVR coverage rules while watching for self-referral, hospitals sued to stop the 340B rebate pilot, and CMS named the 2,217 hospitals entering mandatory joint replacement payment in 2028.
FDA approved Edwards’ Autus valve, the first heart valve built to grow with a child. President Trump announced $90 payments to Medicare enrollees a month before the midterms, and CMS’s 2027 data show Medicare Advantage insurers cutting plans and benefits.
CMS canceled marketplace coverage for more than 760,000 people and froze new broker registrations, the White House dropped its plan for political review of NIH grants, and FDA advisers backed the first multicancer blood test.
The White House moved toward a veto over NIH grants this week, and new records showed how hastily Medicare launched its AI prior-authorization pilot.
Medicare rewrote the coverage standard for TAVR this week and quietly opened a second one for aortic regurgitation.
Comment season closed on the 2027 payment rules and hospitals answered on every front at once, medical societies wrote their own vaccine schedule, and Edwards’ size-adjustable pulmonary valve reached its first American patient.
HHS opened a comment period on whether vaccines should still be routinely recommended, CMS put its RAPID device coverage pathway out for comment and paused TCET for new candidates, and No Surprises Act arbitration passed $22 billion in cost.
Trump narrowed the childhood vaccine schedule and ordered an MMR split, the Fifth Circuit voided the No Surprises payment benchmark, and new data showed insurers denying up to 18% of prior authorization requests.
CMS published its RAPID device coverage notice against a payment rule that already closed a different door, joint replacement bundles go mandatory nationwide, and the ACA marketplace enters 2027 renewal sicker, pricier and in court.
Savage Health Policy
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