New York Announces Platform to File PBM Complaints Easier

April 9, 2025

EGWP marketplace medicaid Medicare

Gov. Kathy Hochul (D) recently announced the development of Department of Financial Services (DFS) Connect, a digital platform for New Yorkers to file complaints about drug price spikes. “Local small pharmacies” will also be able to use DFS Connect to seek assistance in resolving claims against PBMs.

The new platform replaces an outdated system and has the goal of giving New Yorkers a voice in keeping drugs affordable, improving oversight, and ensuring better services. According to DFS, since January 2022, they have received more than 300 complaints about PBMs and have recovered a total of more than $1.3 million for pharmacies and consumers.

legislation

CMS Releases Final 2026 MA Policy and Technical Rule; Declines to Finalize Coverage of GLP-1s

On April 4, the Centers for Medicare & Medicaid Services (CMS) finalized the 2026 MA Policy and Technical Changes rule. Of note, CMS is not finalizing certain provisions from the proposed rule, most importantly the proposal requiring coverage of anti-obesity medications (AOMs) in both Medicare and Medicaid. CMS said that it may address these proposals […]
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April 9, 2025

EGWP marketplace medicaid Medicare

legislation

Budget Reconciliation Process Continues with Senate Consideration of Revised House Resolution

On April 5, the Senate voted 51-48 to pass a modified version of the House-passed budget resolution with reduced deficit reduction targets for Senate committees as compared to the House. Specific to health care, the revised Senate resolution instructs the Senate Finance Committee (SFC), which has jurisdiction over Medicaid, to propose changes that will increase […]
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April 9, 2025

medicaid

legislation

2026 Final Rate Announcement for MA and Final Part D Program Instructions

On April 7, CMS released the Calendar Year (CY) 2026 MA and Part D Final Rate Announcement and the Final CY 2026 Medicare Part D Program Instructions. The Administration strongly defended its focus on fraud, waste, and abuse, while protecting beneficiaries. The final rate notice increases average payments to MA plans by 5.06% up from […]
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April 9, 2025

EGWP medicaid Medicare

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CMS Releases Final 2026 MA Policy and Technical Rule; Declines to Finalize Coverage of GLP-1s

On April 4, the Centers for Medicare & Medicaid Services (CMS) finalized the 2026 MA Policy and Technical Changes rule. Of note, CMS is not finalizing certain provisions from the proposed rule, most importantly the proposal requiring coverage of anti-obesity medications (AOMs) in both Medicare and Medicaid. CMS said that it may address these proposals […]
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April 9, 2025

EGWP marketplace medicaid Medicare

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Budget Reconciliation Process Continues with Senate Consideration of Revised House Resolution

On April 5, the Senate voted 51-48 to pass a modified version of the House-passed budget resolution with reduced deficit reduction targets for Senate committees as compared to the House. Specific to health care, the revised Senate resolution instructs the Senate Finance Committee (SFC), which has jurisdiction over Medicaid, to propose changes that will increase […]
read more >

April 9, 2025

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2026 Final Rate Announcement for MA and Final Part D Program Instructions

On April 7, CMS released the Calendar Year (CY) 2026 MA and Part D Final Rate Announcement and the Final CY 2026 Medicare Part D Program Instructions. The Administration strongly defended its focus on fraud, waste, and abuse, while protecting beneficiaries. The final rate notice increases average payments to MA plans by 5.06% up from […]
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April 9, 2025

EGWP medicaid Medicare

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Senate Finance Committee Advances Dr. Oz’s Nomination for CMS Administrator

On March 25, the Senate Finance Committee voted 14-13 along party lines to advance the nomination of Dr. Mehmet Oz as CMS Administrator. During the confirmation hearing, Chair Mike Crapo (R-ID) and other Republicans expressed strong support for Dr. Oz, citing his prior experience as a physician and health advocate. Democrats however scrutinized the nomination. […]
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April 9, 2025

EGWP marketplace medicaid Medicare

legislation

HHS Announces Major Reorganization and Reduction

On March 27, the Department of Health and Human Services (HHS) announced it is restructuring in accordance with a recent executive order to reduce the size of the government’s workforce. HHS is reducing its workforce by about 10,000 full-time employees. When combined with previous HHS efforts, the restructuring results in the department downsizing from 82,000 workers […]
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April 9, 2025

EGWP marketplace medicaid Medicare