Author: Elizabeth Blessing
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The Medicaid rule would scrap an alternative test that lets states tax hospitals past the usual 6 percent limit
A second piece of the same Medicaid financing overhaul targets a technical rule that has quietly let some states tax hospitals more heavily than the usual federal limit allows. The Centers for Medicare & Medicaid Services wants to eliminate what regulators call the 75/75 test, an alternative path that can let a provider tax exceeding…
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Colorado has approved none of next year’s requested health increases yet
Colorado insurance companies filed for a weighted average 13.4 percent premium increase on individual health plans for 2027, with one carrier asking for as much as 23.9 percent. None of those numbers are prices yet. As of today, the Colorado Division of Insurance has not approved a single one of next year’s requested individual-market rate…
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Colorado insurers want 13.4 percent more for individual health plans next year, and one carrier asked for 23.9 percent
Colorado’s insurance regulator released preliminary 2027 premium filings from health insurers in late July, and buried in that filing data is a bigger number than the one the state highlighted in its own headline. Insurers filed for a weighted average request of 13.4 percent more across Colorado’s individual market for next year, with one carrier’s…
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A lab reported skin cancer results after its own control samples fell out of range
When a lab runs a genetic test, it isn’t just testing the patient’s sample. Built into every test run is a “control” sample with a known, expected result, run alongside the real one specifically to prove the equipment and chemistry are working correctly that day. According to the Justice Department, a California skin-testing company reported…
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A skin cancer testing company will pay up to $5 million after billing Medicare for results its own checks had flagged
DermTech, the California lab behind an adhesive-patch skin test marketed as a needle-free alternative to a mole biopsy, has reached a deal with the Justice Department over how it billed Medicare for that test. The company, now unwinding in Chapter 11 bankruptcy as DTech Liquidating Inc., is turning over an allowed unsecured bankruptcy claim of…
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Insurers told the government in June which Medicare Advantage plans they would not renew, and members hear in October
Long before any Medicare Advantage member gets a letter about their plan disappearing, the insurer running that plan has already told the federal government its decision. Federal regulation requires a Medicare Advantage organization to notify the Centers for Medicare & Medicaid Services in writing by the first Monday in June if it won’t renew its…
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About 2.28 million people on Medicare filled Ozempic, Rybelsus or Wegovy in one year, costing plans $15.16 billion
No drug on Medicare’s newly negotiated price list cost the program more in 2024 than the trio of Ozempic, Rybelsus and Wegovy. All three are versions of the same active ingredient, semaglutide, sold by Novo Nordisk under different brand names for different uses. Together they were dispensed to about 2.28 million people with Medicare Part…
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The 85 percent cut on the diabetes pill Janumet works out to $80 a month, down from $526
Of the 15 drugs Medicare negotiated new prices for in its second round of talks, none got a bigger percentage discount than Janumet. Merck has agreed to sell the diabetes pill to Medicare drug plans for $80 for a 30-day supply starting January 1, 2027, down from a $526 list price in 2024. That’s an…
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The negotiated Medicare price for the bowel drug Linzess is $136 a month, against a $539 list price
Linzess is not a specialty cancer drug or a rare-disease treatment. It’s a capsule millions of Americans with chronic constipation or irritable bowel syndrome take every day, and it’s now one of the 15 drugs Medicare has negotiated a lower price for. Starting January 1, 2027, a Medicare drug plan will pay AbbVie $136 for…
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A month of the prostate cancer drug Xtandi will cost a Medicare drug plan $7,004 in January instead of $13,480
Astellas Pharma has agreed to sell Xtandi, one of the most widely used prostate cancer drugs on the market, to Medicare drug plans for $7,004 for a 30-day supply starting in January 2027. That’s down from the $13,480 the same supply cost at list price in 2024, a discount of 48 percent. The new number…
