Category: Medicare
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STAT+: HHS adviser hopes prior authorization reform happens in ‘double-digit months,’ not years
STAT+: HHS adviser hopes prior authorization reform happens in ‘double-digit months,’ not years WASHINGTON — A top U.S. health official told a room full of doctors on Wednesday that he hopes the Trump administration’s efforts to whittle down the insurance industry’s use of prior authorizations will produce results “in double-digit months” instead of years, calling…
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STAT+: Drugmakers lay out their legal arguments against Trump’s drug pricing experiments
STAT+: Drugmakers lay out their legal arguments against Trump’s drug pricing experiments WASHINGTON — The pharmaceutical and biotech industries are pushing back against two Trump administration proposals that would test plans to lower drug prices in Medicare by aligning them with the prices paid in other rich countries. Their comments preview arguments that they might…
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The high stakes for Huntington’s patients
The high stakes for Huntington’s patients Biotech company UniQure is set to meet with the Food and Drug Administration to discuss the path forward for its gene therapy for Huntington’s disease, and the outcome could be potentially devastating for patients. That’s what patient advocate Lauren Holder says on the latest episode of “The Readout LOUD,”…
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STAT+: Trump administration proposes tiny pay raise to 2027 Medicare Advantage plans
STAT+: Trump administration proposes tiny pay raise to 2027 Medicare Advantage plans The Trump administration plans to increase payments to next year’s Medicare Advantage plans by less than 0.1% on average — far below what the industry had expected. Several Wall Street analysts expected pay increases of 4%-6%, but a crucial measure of Medicare spending…
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STAT+: Three major health care policy issues to watch in 2026
STAT+: Three major health care policy issues to watch in 2026 WASHINGTON — Health care figured prominently in the first year of President Trump’s second term, and it’ll likely play an even bigger role leading up to the 2026 midterm elections. The shift back to health care politics has been somewhat surprising. Although Republicans were…
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Opinion: Proposed HHS rule on gender-affirming care radically expands use of Medicare, Medicaid as policy weapons
Opinion: Proposed HHS rule on gender-affirming care radically expands use of Medicare, Medicaid as policy weapons Last Thursday, the Trump administration released a proposed rule prohibiting hospitals that receive Medicare or Medicaid funding from providing any gender affirming care to minors, even when privately funded. This rule will foreclose access to gender-affirming care for families seeking…
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STAT+: Trump moves to require lower drug prices in Medicare
STAT+: Trump moves to require lower drug prices in Medicare You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. The NIH director did the Pete & Bobby fitness challenge, but I didn’t see…
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STAT+: Major pharma companies may avoid Medicare experiments’ forced price cuts
STAT+: Major pharma companies may avoid Medicare experiments’ forced price cuts Many of the largest drugmakers may be exempt from Medicare pilot programs intended to force them to lower some of their prices, potentially undermining the effort and depriving American patients of cheaper drugs. Several of the 14 pharmaceutical companies that have struck individual drug-pricing…
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STAT+: Trump administration proposes Medicare pilots to lower drug prices on par with peer countries
STAT+: Trump administration proposes Medicare pilots to lower drug prices on par with peer countries WASHINGTON — The Trump administration proposed two Medicare pilot programs to reduce prices for branded drugs bought at pharmacy counters and administered in doctor offices. If the administration moves forward, the programs could slash Medicare spending on prescription drugs by…
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In major effort to end gender-affirming care, Trump administration takes aim at hospitals
In major effort to end gender-affirming care, Trump administration takes aim at hospitals The Trump administration is making its most forceful attempt yet at restricting gender-affirming care for transgender youth in the U.S. The Centers for Medicare and Medicaid Services proposed on Thursday two rules to withhold federal funds in connection with gender-affirming care for…
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STAT+: Medicare routes $16 billion to insurers to offset high drug costs
STAT+: Medicare routes $16 billion to insurers to offset high drug costs The federal government has sent a record $16 billion to health insurers that sell Medicare drug plans, a flashing red sign that prescription drug spending is blowing up far beyond what government officials and insurance experts had expected. The good news for Medicare…
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STAT+: ACA tax credits cool, while BIOSECURE heats up
STAT+: ACA tax credits cool, while BIOSECURE heats up You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. MAHA Action has a holiday shop for all your MAHA gift giving needs. Or you can click over…
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Opinion: Pharmacies will be the canary in the coal mine on the Medicare drug price negotiations
Opinion: Pharmacies will be the canary in the coal mine on the Medicare drug price negotiations The Centers for Medicare and Medicaid Services recently announced negotiated prices for 15 drugs, finalizing the second iteration of the Medicare Drug Price Negotiation Program. The first set of negotiated drug prices will go into effect in January 2026.…
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STAT+: Medicare Advantage plans to gain $13 billion under Trump changes to star ratings
STAT+: Medicare Advantage plans to gain $13 billion under Trump changes to star ratings Medicare Advantage insurers scored a Thanksgiving gift, as President Trump’s Medicare agency added back a bonus system that rewards health plans with consistently high marks. The Centers for Medicare and Medicaid Services also is proposing to eliminate a dozen star ratings…
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In Medicare drug negotiations, Trump administration embraces a policy the GOP once despised
In Medicare drug negotiations, Trump administration embraces a policy the GOP once despised WASHINGTON — On Tuesday, the Trump administration celebrated drug price cuts it had secured through a Democrat-created program — despite Republicans’ longstanding antipathy toward the policy. The Inflation Reduction Act, a 2022 law supported solely by Democrats and signed into law by…
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STAT+: Medicare backs off plan for quicker clawback of $7.8 billion from hospitals
STAT+: Medicare backs off plan for quicker clawback of $7.8 billion from hospitals Hospitals scored a win in Medicare’s final outpatient payment rule for 2026, as they persuaded federal Medicare officials to back off a plan that would have clawed back $7.8 billion a decade sooner than originally planned. However, hospitals didn’t get everything they…
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STAT+: A revelatory profile of RFK Jr.
STAT+: A revelatory profile of RFK Jr. You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. I haven’t read Olivia Nuzzi’s new book, but I dare say my favorite line about her relationship…
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STAT+: Medicare premiums to jump 10% heading into 2026
STAT+: Medicare premiums to jump 10% heading into 2026 Most Medicare enrollees will face premiums that are 10% higher next year, creating budget anxiety for millions of seniors. Older adults and people with disabilities will pay almost $203 per month in 2026 for their Medicare Part B premium, the Trump administration said late Friday. That’s…
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STAT+: UnitedHealthcare drops remote monitoring coverage in defiance of Medicare policies
STAT+: UnitedHealthcare drops remote monitoring coverage in defiance of Medicare policies Beginning in January, UnitedHealthcare will no longer pay physicians to remotely monitor the data that patients collect at home about chronic conditions like hypertension. The updated medical policies for both Medicare and commercial health plans from the country’s largest insurer were posted in September…
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STAT+: Seven burning questions about Trump’s big deal for cheaper weight loss drugs
STAT+: Seven burning questions about Trump’s big deal for cheaper weight loss drugs WASHINGTON — The Trump administration’s deal to expand access to and lower the cost of weight loss drugs has left industry leaders, public health experts, and patients with a host of open questions. The administration’s agreements with Eli Lilly and Novo Nordisk…
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STAT+: Kennedy, a longtime pharma critic, embraces Trump deal to expand access to obesity drugs
STAT+: Kennedy, a longtime pharma critic, embraces Trump deal to expand access to obesity drugs WASHINGTON — Health Secretary Robert F. Kennedy Jr. was uncharacteristically chummy with pharma executives at the White House on Thursday as he cheered the Trump administration’s plan for lowering obesity medication prices. Kennedy has railed against drugmakers in the past, and…
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STAT+: Trump administration nears deals for cheaper weight loss drugs with Novo Nordisk, Eli Lilly
STAT+: Trump administration nears deals for cheaper weight loss drugs with Novo Nordisk, Eli Lilly WASHINGTON — The Trump administration is nearing deals with Eli Lilly and Novo Nordisk to lower the prices of their weight loss drugs and expand access to them, people familiar with the talks told STAT. The companies have been close to…
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STAT+: Medicare finalizes rule to lower payments for surgeries
STAT+: Medicare finalizes rule to lower payments for surgeries Medicare on Friday followed through with its earlier proposal to reduce payment for surgeries, outpatient procedures, and other services it believes can be done more efficiently starting in 2026. The controversial move represents a significant change to how thousands of physician services are priced under Medicare.…
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STAT+: CBO says revised cost of orphan drug exemptions will add $3.9 billion to Medicare
STAT+: CBO says revised cost of orphan drug exemptions will add $3.9 billion to Medicare The Congressional Budget Office has revised its forecast showing the recently enacted One Big Beautiful Bill Act will cost taxpayers as much as $8.8 billion — up from earlier estimates of $4.9 billion — over 10 years thanks to provisions…
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STAT+: Medicare payments to doctors paused as government shutdown drags on
STAT+: Medicare payments to doctors paused as government shutdown drags on The Centers for Medicare and Medicaid Services is pausing Medicare payments to doctors, as negotiations tied to the government shutdown drag on. CMS announced the pause in a notice on its website but didn’t say when it would end. It’s happening because Congress needs…
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STAT+: Medicare Advantage insurers still in retreat as annual enrollment kicks off
STAT+: Medicare Advantage insurers still in retreat as annual enrollment kicks off Medicare Advantage has skyrocketed in popularity over the past decade, reeling in new members with zero-dollar premiums and generous benefits. But the rate of growth has slowed in recent years, and in 2026, there’s a decent chance enrollment will contract for the first…
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Home hospital programs in ‘terror’ as they grind to halt ahead of government shutdown
Home hospital programs in ‘terror’ as they grind to halt ahead of government shutdown On any given day, dozens of patients waiting for hospital rooms line the hallways of the emergency department at UMass Memorial Medical Center’s University Campus. It’s one reason the Worcester-based health system dove into delivering home hospital care four years ago. …
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Opinion: Dental care is increasingly under threat in the U.S.
Opinion: Dental care is increasingly under threat in the U.S. Major shifts in public health policy can bring unforeseen consequences. But in the case of fluoride bans, we already know what the consequences will be: higher costs of dental care, and higher rates of tooth decay — especially among children. This is particularly alarming because…
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STAT+: How Trump may use Democrats’ drug-price negotiation law
STAT+: How Trump may use Democrats’ drug-price negotiation law You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. I’m happy to report that Last Week Tonight with John Oliver did a segment on…
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STAT+: What the GOP’s cuts to public broadcasting have to do with health care policy
STAT+: What the GOP’s cuts to public broadcasting have to do with health care policy WASHINGTON — Congressional Republicans early on Friday morning passed legislation to take back money they had already appropriated for this year, enacting steep cuts to foreign aid and to public broadcasting. And while none of the funding was for domestic…
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STAT+: Centene’s stock plummets as health insurance giant scraps 2025 financial outlook
STAT+: Centene’s stock plummets as health insurance giant scraps 2025 financial outlook Centene has withdrawn its financial guidance for the rest of the year after receiving data that showed its health insurance members in Affordable Care Act plans are getting a lot more care than the company had anticipated. The company is also seeing a…
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STAT+: Cassidy is circulating a proposed law to push down U.S. drug prices, backing a key Trump ambition
STAT+: Cassidy is circulating a proposed law to push down U.S. drug prices, backing a key Trump ambition WASHINGTON — Senate health committee Chair Bill Cassidy (La.) is the latest Republican to take an interest in legislation that would tie U.S. brand drug prices to lower prices in other wealthy countries, according to seven people…
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STAT+: Lawmakers lobby doctors to keep quiet — or speak up — on Medicaid cuts in Trump’s tax bill
STAT+: Lawmakers lobby doctors to keep quiet — or speak up — on Medicaid cuts in Trump’s tax bill WASHINGTON — With millions of people at risk of losing health insurance under President Trump’s tax bill, lawmakers have begun lobbying the lobbyists: asking health care interests to keep quiet — or speak up — about…
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STAT+: Our biggest burning questions on Trump’s order to bring down drug prices
STAT+: Our biggest burning questions on Trump’s order to bring down drug prices WASHINGTON — President Trump’s executive order to lower drug prices through sweeping, cross-agency action left leaders in the pharmaceutical industry scrambling Monday to make sense of what may be ahead — and how to respond. The announcement was long on messaging, but…
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STAT+: More Medicare plans cover Humira biosimilars, but do little to encourage patient use
STAT+: More Medicare plans cover Humira biosimilars, but do little to encourage patient use Medicare drug plans significantly boosted coverage of biosimilar versions of the Humira rheumatoid arthritis medicine this year, but nearly all of them failed to take steps that would encourage greater use of these alternative treatments, a new government watchdog report finds.…
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STAT+: Supreme Court sides with HHS on formula used to pay hospitals for treating low-income patients
STAT+: Supreme Court sides with HHS on formula used to pay hospitals for treating low-income patients The Supreme Court on Tuesday rejected hospitals’ argument that the federal government doesn’t pay them enough for treating low-income patients. The seven-justice majority instead sided with the Department of Health and Human Services’ interpretation of the law concerning disproportionate…
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STAT+: Trump gives major lift to 2026 Medicare Advantage payments
STAT+: Trump gives major lift to 2026 Medicare Advantage payments Health insurers that sell Medicare Advantage plans are going to get about $30 billion more in taxpayer money next year. President Trump’s Medicare agency finalized a rule Monday that would raise benchmark payment rates to privatized Medicare plans by 5.1% for 2026. That was higher…
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STAT+: Medicare gets a big (unofficial) surprise: a 17-year extension on when it’ll run dry
STAT+: Medicare gets a big (unofficial) surprise: a 17-year extension on when it’ll run dry Medicare’s financial future unexpectedly got a lot rosier, at least according to some federal budget wonks. The Congressional Budget Office recently published its long-term predictions of the federal budget and buried a big surprise for people who follow the Medicare…
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Senate confirms Oz as head of agency that runs Medicare, Medicaid
Senate confirms Oz as head of agency that runs Medicare, Medicaid WASHINGTON — In a party-line vote of 53-45, the Senate on Thursday confirmed Mehmet Oz to lead the Centers for Medicare and Medicaid Services. Oz’s confirmation was expected; he is not as controversial as Health and Human Secretary Robert F. Kennedy Jr. or some…