Key regulatory and legislative developments shaping U.S. healthcare and insurance in late 2025, including APTC expirations, CMS innovations, FDA initiatives, and congressional healthcare policy efforts.
CMS's current inclusion of noncovered self-administered drug prices in Medicare Part B payment calculations inflates costs for Stelara biosimilars. OIG recommends revising pricing methodology to achieve savings.
U.S. states leverage unused ACA Marketplace premiums to fund abortion services for low-income and uninsured populations, navigating legal frameworks under Section 1303 and CMS guidance challenges. Insight into regulatory compliance and health policy impacts.
CMS 2027 Proposed Rule aims to modernize Medicare Advantage and Part D programs with updates to quality metrics, risk adjustment models, and beneficiary protections. Key changes include Star Ratings revisions, incorporation of Inflation Reduction Act drug pricing provisions, and requests for stakeholder feedback on quality bonus payments and care coordination.
CMS has published 24 quality and efficiency measures for Medicare programs, emphasizing digital data use and targeting chronic conditions and safety priorities. Public commentary is open through January 6.
CMS reviews Obamacare enhanced subsidy issues; VA plans healthcare workforce reductions; vaccine injury program advisory panel to meet post-Christmas.
CMS announces nearly 5.8 million consumers have enrolled in 2026 health plans through the federally facilitated Health Insurance Marketplace during the ongoing open enrollment period ending January 15.
CMS and FDA announce ACCESS and TEMPO initiatives to expand technology-enabled care for Medicare beneficiaries with chronic conditions, focusing on outcomes-based payments and regulatory enforcement discretion.
CMS updates Medicare Local Coverage Determinations for skin substitute grafts in 2026, impacting coverage for diabetic foot and venous leg ulcers with evidence-based criteria and new product classifications.
FlyteHealth recognized by CMS for its precision cardio-kidney-metabolic care model in the Medicare ACCESS program, advancing scalable chronic disease management with AI and personalized interventions.
