Blog Archive

Employer Oversight of Pharmacy Benefits in Self-Insured Health Plans

Employer-sponsored insurance (ESI) is the predominant source of health coverage for working-age Americans. For these beneficiaries, decisions made by their employers regarding pharmacy benefit design can directly shape…

NVHPF Considers Impacts of International Reference Pricing in U.S. Drug Pricing Models

On August 27, 2026, the Northern Virginia Health Policy Forum hosted a discussion on the global implications of the United States’ adoption of Most Favored Nation (MFN) drug…

States Move on PBM Vertical Integration as Congress Weighs Reform

Pharmacy benefit managers (PBMs) have become a major focus of healthcare policy, as policymakers, regulators, and other stakeholders debate the industry’s business practices and models. Congress addressed PBM…

340B Program Faces New Reimbursement Cuts, Accelerated Clawbacks, and Growing Reform Efforts

In January 2026, Applied Policy reported that the Centers for Medicare & Medicaid Services (CMS) planned to conduct an Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey…

CMS Begins Building a New Medicare Payment Framework for Diagnostic Software

Provisions in the recently released CY 2027 Outpatient Prospective Payment System (OPPS) and Physician Fee Schedule (PFS) proposed rules indicate that the Centers for Medicare & Medicaid Services…

DOJ Issues First Healthcare Declination Under New Corporate Enforcement Policy

The Trump administration has made combating healthcare fraud a priority. From the Centers for Medicare & Medicaid Services’ “Medicaid Fraud War Room” to the Department of Justice’s “whole-of-government”…

As Medicaid Eligibility Requirements Shift, Presumptive Eligibility Could Offer a Path to Coverage Continuity and Financial Stability

Recent federal changes to Medicaid are expected to disrupt coverage for millions of beneficiaries. While some individuals will no longer qualify for Medicaid, others who remain eligible may…

CMS Finalizes 2.3% Payment Update for Hospices in FY 2027

On July 30, 2026, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2027 Medicare Program; FY 2027 Hospice Wage Index and Payment Rate…

CMS Finalizes 2.3% FY 2027 IPPS Payment Update, Increases Uncompensated Care Payments, Expands Mandatory Episode-Based Payment, & Revises GME and Cost-Reporting Policies

On July 31, 2026, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2027 Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals…

FY 2027 IRF PPS Final Rule Signals Modest Growth and Broader Payment Reform Direction

On July 30, 2026, the Centers for Medicare & Medicaid Services (CMS) released the fiscal year (FY) 2027 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) final rule.…

CMS Finalizes FY 2027 Payment Update and Quality Changes for Inpatient Psychiatric Facilities

On July 29, 2026, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2027 final Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Rate…

CMS Issues CY 2027 Physician Fee Schedule Proposed Rule with Reduced Physician Payment Rates, Telehealth Expansions, and MSSP Reforms

On July 14, 2026, the Centers for Medicare & Medicaid Services (CMS) issued its proposed calendar year (CY) 2027 Physician Fee Schedule (PFS), which proposes policies for physician…

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