Plaintiffs Say CMS’ Frailty Rule Raises Projected Medicaid Losses From 6.4 Million to 8.2 Million a Year
Congress named who is medically frail. CMS’s rule decides who can prove it, and the new lawsuit is about that gap.
Market Access
CMS Cancelled Coverage for 760,000 People and Froze New Brokers for 2027 Over Unauthorized Enrollments
CMS frames this as fraud recovery. Its release says much less about the 760,000 people whose marketplace coverage ends.
UnitedHealthcare Is Enlisting Doctors Against the Paperwork Behind 43% of Projected Medicaid Losses
CMS expects much of the coverage loss to come from process, not from failing the test. The insurer asked doctors to help.
India Got Three Different Access Mechanisms in Four Days
Three routes to patients in four days. In a market that pays out of pocket, not one announcement carries a price.
GENEROUS Signings Jump From Seven to 40 States in a Week
Forty states signed. Reporting last week put it at seven. The list CMS has never published is the manufacturers.
Korea Repriced 36 Fewer Items This Year and Took Out the Same ₩33.9 Billion
Thirty-six fewer items produced the same saving. Nothing about efficacy changed. The medicines that grew paid for it.
NICE Wants Cosmetic Providers to Screen for BDD and Refer Rather Than Operate
Coverage will call this a mental health guideline. One recommendation reaches into a commercial market and tells its providers to turn business away.
GENEROUS Lets Manufacturers Cut Medicaid Prices Without Touching Best Price or 340B
Seven of 19 applicant states have signed. CMS itself tells them to check whether its international price beats the rebates they already have.
Korea’s Reimbursement Delay Is a Staffing Problem, and the Ministry Said So
An industry association found the public agrees with industry. The news came later, from a division director naming headcount as the bottleneck.
CMS Added Five Tracks to ACCESS. The Payer Pledge Covers 165 Million People Who Cannot Join It.
The expansion is the announcement. Payers covering 165 million pledged to align with a model none of their members can join.