Hill hot list: Medicare Advantage & Dr. Oz
By HME News Staff
Updated 8:58 AM CDT, Mon April 7, 2025
WASHINGTON – CMS issued a Medicare Advantage final rule on April 4 that does not finalize Part D coverage of obesity medications for Medicare and Medicaid.
The rule also does not finalize two other proposals: “Enhancing Health Equity Analyses: Annual Health Equity Analysis of Utilization Management Policies, Procedures”; and “Ensuring Equitable Access to Medicare Advantage Services—Guardrails for Artificial Intelligence.”
The rule does finalize the proposal to codify the statutory requirements that, effective for plan years beginning on or after Jan. 1, 2023, the Medicare Part D deductible does not apply to covered insulin products, and the Part D cost-sharing amount for a one-month supply of each covered insulin product must not exceed the covered insulin product applicable cost-sharing amount.
For 2026 and each subsequent year, the applicable cost-sharing amount is the lesser of:
- $35;
- An amount equal to 25% of the maximum fair price established for the covered insulin product under the Medicare Drug Price Negotiation Program; or
- An amount equal to 25% of the negotiated price, as defined in § 423.100, of the covered insulin product under the stand-alone Medicare prescription drug plan (PDP) or MA plan with prescription drug coverage (MA-PD plan).
For more provisions in the rule, go here.
Dr. Mehmet Oz on April 3 was confirmed as CMS administrator by the full Senate. The chamber voted along party lines 53 to 45. For a peek at what he might do as administrator, read our roundup of his hearing before the Senate Finance Committee.
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