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Medicare Part D to Cover Weight-Loss Treatments Beginning in 2027

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Starting in 2027, participating Medicare Part D plans may begin covering weight-loss medications under CMS’ voluntary BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) model. The announcement follows federal negotiations aimed at securing more favorable pricing for obesity and diabetes treatments. Recent data analysis from KFF, based on CMS data from 2019–2024, shows a dramatic rise in GLP-1 medication use and spending among Medicare beneficiaries. Use of Ozempic grew from fewer than 150,000…
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FTC Reaches Settlement with Express Scripts Over Insulin Pricing

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The Federal Trade Commission (FTC) has reached a settlement with Express Scripts, Cigna’s pharmacy benefit manager (PBM), in a case centered on alleged insulin price inflation. The agreement is expected to reduce out-of-pocket drug costs — including insulin — by an estimated $7 billion over the next decade. Under the settlement, Express Scripts must delink manufacturer compensation from drug list prices, avoid favoring higher-priced drugs over lower-cost alternatives, and ensure patient cost-sharing is based on…
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Key CMS Billing and Payment Updates for 2026

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CMS released several updated MLN Matters® articles outlining important billing, payment, and coverage changes taking effect in 2026. These updates impact ESRD facilities, ambulatory surgical centers, rural health clinics, and preventive services. Acute Kidney Injury & ESRD Billing UpdatesBeginning July 1, 2026, ESRD facilities will no longer be required to submit the AX modifier on certain ESRD PPS claims eligible for add-on payment adjustments. CMS also issued new billing instructions for hemodiafiltration and acute kidney…
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Federal Budget Deal Delivers Key Healthcare Wins—With Major Telehealth Extension

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The latest federal budget agreement includes several healthcare provisions supported by the American Medical Association, delivering meaningful updates for physicians and patients. Among the most impactful outcomes is a renewed commitment to telehealth access, along with additional reforms focused on care delivery, physician support, and cost transparency. 1. Medicare telehealth coverage extended for two yearsMedicare telehealth flexibilities have been renewed through 2027, restoring continuity of care after a 43-day lapse tied to the 2025 government…
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Understanding the Stark Law In-Office Ancillary Services Exception

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The in-office ancillary services exception is one of the most commonly used Stark Law exceptions, allowing physician practices to provide designated health services—such as labs, imaging, and therapy—within the practice without violating self-referral rules. Compliance, however, depends on meeting several technical requirements where practices often get tripped up: 1. Three core requirements must be metServices must be provided under appropriate physician supervision, furnished in the group’s office or a centralized patient-care location, and billed by…
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CMS Finalizes Separate Medicare Payment for Non-Opioid Pain Devices in ASCs

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CMS has confirmed that ambulatory surgery centers will continue to receive separate Medicare reimbursement in 2026 for certain non-opioid pain management devices under the NOPAIN Act, including three approved products used in ASC and outpatient hospital settings. The decision reinforces ongoing efforts to support non-opioid pain management options following surgical procedures when medically necessary. Resource: CMS finalizes separate payment for 3 non-opioid ASC pain devices

Measles Cases Rise Early in 2026, Prompting Public Health Concern

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Just one month into 2026, the U.S. has already reported 588 confirmed measles cases—about 25% of the total cases recorded in all of 2025—raising concerns that this year could surpass recent annual totals if current trends continue. Several states are experiencing significant outbreaks, with discrepancies between state-reported and federally confirmed case counts, and public health officials are monitoring whether sustained transmission could impact the U.S.’s long-standing measles elimination status. Resource: 1 month into 2026, measles…
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Overview of Alabama’s Medical Cannabis Physician Certification Process

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The Alabama Medical Cannabis Commission has begun issuing dispensary licenses, allowing the Board of Medical Examiners (BME) to accept applications from physicians seeking certification to recommend medical cannabis. Under Alabama requirements, physicians must complete a four-hour medical cannabis education course and pass a subsequent examination to become a registered certifying physician. A two-hour refresher course is required every two years to maintain certification. All required coursework and examinations are administered through the Medical Association. The…
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Healthcare Updates Impacting Providers and Patients

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Flat 2027 Medicare Advantage payment rate may drive insurers out of marketsA flat Medicare Advantage payment rate for 2027, combined with rising costs, is prompting some major insurers to scale back or exit unprofitable markets—potentially limiting plan options for millions of beneficiaries in certain states and counties. Does inaccurate health information get more views on TikTok?As more young people turn to TikTok for health information, medical student researchers examined whether misleading or inaccurate content spreads…
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FDA Approves New Eye Drops for Presbyopia That May Reduce the Need for Reading Glasses

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The FDA has approved carbachol/brimonidine tartrate ophthalmic solution (Yuvezzi) for the treatment of presbyopia in adults, making it the first dual-agent eye drop approved for age-related near-vision loss. The once-daily drops combine two active ingredients with different mechanisms of action, distinguishing them from previously approved single-agent presbyopia treatments. Clinical support for the approval came from the phase III BRIO I and BRIO II trials, which demonstrated statistically significant improvements in near vision without compromising distance…
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2026 MVPs and Measures & Activities

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2026 Explore MVPs Providers interested in reporting a MIPS Value Pathway (MVP) should review the MVPs finalized for the 2026 performance year to determine whether an option aligns with their scope of care and practice. To participate in MVP reporting for 2026, registration is required between April 1 and November 30, 2026. Please note that the group participation option for 2026 MVP reporting is limited to small practices and groups with a single focus of…
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Largest Medicare Advantage Fraud Settlement Highlights Risk Adjustment Enforcement

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Kaiser Permanente has agreed to pay $556 million to resolve allegations that it submitted unsupported diagnosis codes under the Medicare Advantage program, marking the largest settlement of its kind to date. The government alleged that, between 2009 and 2018, diagnosis codes were added that were not supported by clinical documentation, resulting in inflated risk adjustment payments. At the center of the case is Medicare Advantage risk adjustment, which determines plan payments based on the documented…
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