In a first, a drugmaker’s lawsuit challenges HRSA’s 340B patient definition
In a new chapter for litigation involving the 340B Drug Pricing Program, a drugmaker is suing the federal government over the definition of patient as it pertains to the program. AbbVie Inc. says the definition established by the Health Resources and Services Administration (HRSA) in 30-year-old guidance is unwieldy and enables inappropriate access to 340B…
Medicare Advantage 2027 payment update increases after a CMS revision
Belying earlier projections, CMS gave Medicare Advantage (MA) health plans a payment hike for 2027. Payments will increase by 2.48%, or more than $13 billion, according to a final rate notice published April 6. It’s a better outcome for stakeholders than was anticipated when CMS released the advance rate announcement in January. Then, the payment…
Trump’s FY27 HHS budget proposal outlines cuts, operational changes
President Donald Trump’s healthcare budget proposal for FY27 emphasizes Making America Healthy Again (MAHA) priorities and slashes operational costs within HHS. At $111.1 billion, total HHS funding would decrease by $15.8 billion, or $12.5%, relative to FY26. When counting onetime recissions, the effective cut would be nearly $23 billion (from $112.3 billion in FY26 to…
ACA marketplace enrollment declines as subsidies expire in 2026
CMS’s latest 2026 enrollment numbers for the Affordable Care Act (ACA) marketplaces indicate a relatively moderate drop-off from 2025, although the final tally could look notably different. The agency reported this week that 23.1 million were enrolled at the close of open enrollment for Healthcare.gov and the state-run marketplaces. That’s a 4.9% decline from 2025,…
DOJ brings antitrust lawsuits challenging hospital contracting practices
Litigation brought by the U.S. Department of Justice (DOJ) asserts anticompetitive behavior in contracting by two health systems. The allegations in lawsuits filed Feb. 20 against OhioHealth and March 26 against NewYork-Presbyterian (NYP) connect to concerns in the Trump administration about the impact of dominant health systems in some markets. Repeated references in the lawsuits…
Health system PBM ownership model shows benefits amid reform pressure
Amid heightened scrutiny of the pharmacy benefit manager (PBM) model, one health system is touting an alternative approach. St. Louis-based SSM Health is co-owner of Navitus Health Solutions, a PBM with 18 million members among 800 clients across all 50 states. Navitus has a niche that helps it optimally serve customers while bolstering the operation…
CMS’s claims attachments rule sets deadline to shift to full electronic submission
March 30 update CMS sent out an email announcing a town hall to discuss the new final rule. The town hall takes place Tuesday, March 31 between 1 p.m. and 2:30 p.m. Eastern time. No registration is required. The town hall can be joined at this Teams link. As there will not be a live…
MedPAC says hospital payments are sufficient, urges better safety-net targeting
Medicare payment to hospitals is broadly adequate but should be better targeted for lower-resourced facilities, according to a formal recommendation by the Medicare Payment Advisory Commission (MedPAC). In its annual report to Congress on Medicare payment policy, MedPAC said 2027 inpatient and outpatient payments should increase in accordance with the statutory formula and do not…
Hospitals targeted in healthcare affordability debate on Capitol Hill
Large employers are looking to put much of the impetus for improving healthcare affordability on hospitals, according to congressional testimony Wednesday. “Many of the biggest cost increases are driven by hospitals and health systems and can be addressed today,” Elizabeth Mitchell, president and CEO of the large-employer coalition Purchaser Business Group on Health (PBGH), said…
Panel: AI can improve prior authorization in healthcare but won’t solve all the issues
New approaches to prior authorization are crucial to improve a process that remains essential to supporting healthcare quality, according to a subject matter expert. “Prior auth exists because there’s a bell curve of care in the United States,” said Jeremy Friese, MD, founder and CEO of Humata Health, referring to substantial variability “from a safety…