Executive Summary
Key Takeaways
- Prepare for a 2027 revenue squeeze in Medicare Advantage: CMS proposed keeping reimbursement rates nearly flat (0.09% increase) and restricting the "chart reviews" that insurers use to boost payments via upcoding. Source
- New Labor Department rules will force PBMs to disclose drug rebates and fees, potentially saving employers and workers $1 billion annually by exposing historically hidden prescription drug data. Source
- Veeva Systems is challenging Epic Systems' employment covenants in court, arguing that Epic’s non-compete lists and equity repurchase programs facially violate Wisconsin labor statutes. Source
- The United States officially completed its withdrawal from the World Health Organization on January 22, 2026, signaling a pivot toward bilateral health partnerships and private sector-led global health efforts.
Key Themes
Major trends and developments identified from this week's coverage
Data Interoperability and Modernization
Federal agencies are dismantling information silos and modernizing data baselines (USCDI v7) to facilitate the exchange of complex diagnostic images and clinical records.
Managed Care Accountability and Transparency
Insurers and PBMs face intensifying scrutiny over billing practices, with CMS and the Labor Department proposing rules to curb upcoding and hidden fees.
Regulatory Innovation and Flexibility
The FDA is introducing flexibilities in manufacturing (CMC) for cell and gene therapies and modernizing statistical methods to speed rare disease treatments to market.
Key Players
Top companies, people, and technologies mentioned this week
2 articles
Acquired by Health Gorilla, Acquired by State of Texas
3 articles
Child of KFF, Collaborates with Johns Hopkins Bloomberg School of Public Health
3 articles
Child of Department of Health and Human Services, Child of U.S. Department of Health and Human Services
3 articles
Collaborates with Immigration and Customs Enforcement, Collaborates with Office of the National Coordinator for Health Information Technology
2 articles
Child of HHS, Child of U.S. Department of Health and Human Services
2 articles
Collaborates with Ginkgo Biosecurity, Collaborates with North Carolina Department of Health and Human Services
3 articles
Child of Department of Health and Human Services, Child of U.S. Department of Health and Human Services
4 articles
Works with FDA, Works with Food and Drug Administration
2 articles
Works with Centers for Medicare & Medicaid Services, Works with Centers for Medicare & Medicaid Services (CMS)
2 articles
Child of Department of Health and Human Services, Created by CMS-Aligned Network
Regulatory & Policy Updates
FDA approved Zycubo (copper histidinate) for Menkes disease treatment
Approval provides the first life-extending option for an untreatable fatal pediatric condition, reducing risk of death by 78% in early-treated infants.
CMS/MEDICAREHHS finalized a rule closing a Medicaid tax waiver loophole
The rule prevents states from using statistical tests to unfairly target Managed Care Organizations with higher taxes to artificially inflate federal Medicaid matching funds.
STATECalifornia filed a civil rights complaint against CMS Administrator Mehmet Oz
The legal action alleges Oz used racially charged claims of "Russian Armenian mafia" hospice fraud to discriminate against the Armenian community.
FDAFDA issued draft guidance on Bayesian methodology for clinical trials
Modernizing statistical approaches allows for smaller patient populations and adaptive designs, directly benefiting rare disease and pediatric drug development.
Technology & Innovation
ASTP proposed USCDI version 7 with new health data classes
Version 7 transitions away from incremental updates, incorporating diagnostic imaging elements that will become the federal baseline for certified health IT.
FDA ImportShield Program cut product review times by 66%
Consolidated regional teams into a centralized operation to better identify counterfeit medications and contaminated food at ports of entry.
ASTP issued RFI to eliminate CD/DVD reliance for diagnostic imaging exchange
Addressing the PACS-EHR silo aims to move imaging data into standard FHIR-based interoperability workflows, ending patient reliance on physical media.
Market & Competitive Intelligence
UnitedHealth Group
Market EntryUnitedHealth Group lost $62.4 billion in market capitalization in one day following the CMS proposal for nearly flat Medicare Advantage rate increases for 2027.
Health Gorilla
PartnershipHealth Gorilla retained Quinn Emanuel to defend against Epic’s litigation, joining Particle Health and CureIS in a legal front that may pursue affirmative counterclaims against Epic's governance.
Medicare Part D
FundingGross Medicare Part D spending on GLP-1 drugs reached $27.5 billion in 2024, a five-fold increase since 2019, driven by surged utilization for type 2 diabetes.
What to Watch
Expanded Medicare Obesity Coverage
2026-2027 launchThe BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) model will begin expanding obesity drug coverage for Medicaid in 2026 and Medicare in 2027.
CDC Grant Restructuring
Immediate and ongoing review expectedCDC briefly paused $5 billion in public health grants for alignment review; watch for potential restructuring of future grant cycles to favor administration priorities like biosecurity.
Raw Ingredient Supply Chain Oversight
Ongoing investigation through 2026The ByHeart infant formula botulism outbreak (51 infants sickened) has been linked to powdered whole milk; expect increased FDA oversight of dairy-based raw ingredients.
Editor's Picks
AI-recommended articles based on relevance and quality
Global COVID-19 Tracker | KFF
National Institute of Arthritis and Musculoskeletal and Skin Diseases; Notice of Partially Closed Meeting
Eunice Kennedy Shriver National Institute of Child Health and Human Development; Amended Notice of Meeting
National Institute of Nursing Research; Notice of Meeting
Center for Scientific Review; Notice of Closed Meeting
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