Congress returns from recess with five key U.S. health policy priorities including FY26 appropriations, OTC drug fee program reauthorization, drug pricing reform, Medicare/Medicaid extenders, and ACA tax credits.
Explore Medicare coverage limitations for Saxenda, a GLP-1 agonist approved for weight loss, and the implications for obesity drug access and insurance plan strategies.
Medicare Part D enrollees may face significant premium hikes up to $50 monthly in 2025 due to increased drug spending, policy changes, and reduced federal stabilization funding. Compare plans during open enrollment.
CMS plans a voluntary five-year trial allowing state Medicaid and Medicare Part D plans to cover GLP-1 weight management drugs, including Ozempic and Wegovy, starting in 2026-27 amid pricing and coverage challenges.
CMS's price-substitution policy has saved $76 million for Medicare by correcting drug pricing identified by the Office of Inspector General, improving cost efficiency while maintaining access.
Recent Republican-led legislative changes delay Medicare drug price negotiations for costly cancer treatments, maintaining high patient costs and impacting seniors and disabled Americans.
CMS's 2026 proposed rules for Medicare Part B include major updates to average sales price calculations, Inflation Reduction Act compliance, ASP documentation, and Medicare inflation rebates affecting government pricing.
Novo Nordisk expands access to Wegovy with a new self-pay pricing program and pursues legal actions against unauthorized compounded drug sales, impacting the obesity treatment market.
Pfizer and other pharmaceutical firms have discussed most-favored-nation drug pricing with the U.S. government, highlighting potential impacts on insurance and payer strategies.
New analysis shows Inflation Reduction Act provisions will reduce Medicare Part D out-of-pocket costs for specialty drugs etanercept, ustekinumab, and ibrutinib, improving affordability for beneficiaries.
