Top News
CMS Releases Medicare Advantage and Part D Final Rate Notice
On April 6, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Advantage and Part D Rate Announcement for calendar year 2027. The rate announcement finalized a net average increase of 2.48% in MA plan payments, over $13 billion more than in 2026. This is an increase in the agency’s estimate of 0.09% in the advance notice earlier this year. The notice also highlights the following:
CMS will continue to use the 2024 MA risk adjustment model which was calibrated with Original Medicare 2018 diagnoses and 2019 expenditures data and fully implemented in CY 2026, in lieu of the updated risk adjustment model calibrated with Original Medicare 2023 diagnoses and 2024 expenditures data that was proposed in the CY 2027 Advance Notice.
CMS is finalizing updates to the Part D risk adjustment model for CY 2027 to reflect Inflation Reduction Act (IRA) changes, such as phased-in manufacturer discounts. and newer data. The model will exclude diagnoses from audio-only visits and unlinked chart review records and improve accuracy by distinguishing MA prescription drug plans and standalone prescription drug plan populations with separate normalization factors. These updates are critical for plan sponsors to develop accurate CY 2027 bids.
CMS is finalizing updates to the list of eligible disasters for adjustment, non-substantive measure specification changes, and the measures used in Part C and D improvement measures and the Categorical Adjustment Index.
Administrative Action
CDC ACIP Releases Updated Charter
The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) released an updated charter. Typically, the CDC updates the ACIP’s charter without much fanfare every other year. The new charter broadens qualifications for ACIP panel members, allowing Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.’s selections, many of whom have been critical of vaccines, to serve. Further, the updated charter echoes wording used by vaccine critics such as studying “gaps in vaccine safety research” and considering the cumulative effects of vaccinations, which go against scientific consensus. HHS spokesperson Andrew Nixon stated that the updated charter follows routine statutory requirements and “do not signal any broader policy shift”. The updated charter follows Secretary Kennedy’s actions to shift ACIP’s policies towards vaccine skepticism, going against promises he made in his confirmation hearings.
CMS-Backed Prior Authorization Pledge Shows Early Progress; Advocates Push for Legislation
Major health insurers have reported early progress on a voluntary pledge made to the Trump administration in June 2025 to streamline the prior authorization process. According to a survey released Tuesday by America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association, plans that signed the pledge have eliminated prior authorization requirements for 11% of medical services, including more than 15% in Medicare Advantage plans. Services removed from the prior authorization process were those deemed to have clear, evidence-based clinical guidelines and consistent utilization patterns. Insurers also began honoring existing prior authorizations for 90 days when patients switch insurers, a continuity-of-care commitment intended to lay the groundwork for broader reforms. Looking ahead, insurers have committed to responding to at least 80% of electronic prior authorization requests in real time by 2027.
CMS has indicated it is working with stakeholders to extend the pledge to the self-insured market, where plan sponsors determine which services require prior authorization. Industry leaders acknowledge that achieving real-time prior authorization will require both insurers and providers to move away from manual processes and adopt electronic data sharing. Patient advocates are calling on Congress to codify prior authorization reforms into law rather than relying on voluntary industry commitments.
Congressional Action
Senators Wyden and Sanders Call on Committee Leadership to Hold Hearings with Health Insurance CEOs
Senators Ron Wyden and Bernie Sanders sent a letter to Senate committee leadership of the Senate Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee calling for hearings with major health insurance CEOs. The request come amid what the Senators describe as a deepening U.S. health care crisis marked by rising costs, poor outcomes, and growing financial strain on patients. The letter framed a stark contrast between the experiences of Americans – millions of whom are uninsured or facing medical debt –and the financial success of large insurers. The Senators go on to note that these insurers continue to generate tens of billions in profits and provide substantial compensation to their executives. The letter further highlighted concerns about increasing industry consolidation and vertical integration, arguing that insurers’ expanding control across the care continuum enables profit maximization at multiple points in patient care. Within this context, Wyden and Sanders position the requested hearings as a necessary step to examine insurer practices, increase transparency, and hold executives accountable for their role in driving costs and limiting access to care.
Industry Update
PhRMA CEO Announces Departure
The Pharmaceutical Research and Manufacturers of America (PhRMA) is expected to undergo a leadership transition at the end of 2026, as its current CEO, Stephen Ubl, plans to step down after more than a decade leading the organization. During his tenure, Ubl helped guide the pharmaceutical industry’s primary lobbying group through a period marked by heightened scrutiny over drug pricing and increased political attention from both parties. He is credited with shifting PhRMA’s strategy toward a more proactive posture in Washington, including efforts to reframe debates around the drivers of prescription drug costs and to defend industry positions during major policy discussions.
Ubl’s departure comes at a time of evolving dynamics within the pharmaceutical sector and its relationship with policymakers. PhRMA, which represents many of the largest drug manufacturers, has played a central role in shaping federal health policy debates, particularly around pricing reforms and innovation. The leadership transition is expected to mark a new phase for the organization as it navigates ongoing policy debates and broader questions about the role of the pharmaceutical industry in the U.S. healthcare system.
