Final 2027 HIX Rule, Medicaid SDP/DPP Approvals - Mon. 5/18 HeartBeats

Research evidence excerpt

Final 2027 HIX Rule, Medicaid SDP/DPP Approvals - Mon. 5/18 HeartBeats

ies to improve

throughput. The administration is also still finalizing a rule that would revise batching rules,

improve transparency and streamline the federal IDR process. (Inside Health Policy, Amy

Lotven, 5/15/26)

An article • Policy Changes May Be Disrupting Rebate-Driven PBM Market Dynamics:

published in Inside Health Policy explores changes to the PBM market. The authors

of the article suggest that the new model by UnitedHealth Group’s (UNH) Optum Rx

serves as additional proof of growing regulatory and political pressure on traditional PBM

practices, including recent FTC enforcement, federal rebate pass-through mandates, and

state efforts to limit PBM vertical integration. Industry observers cited in the article believe

the sector is shifting toward service-fee-based and rebate-free models as healthcare

costs remain elevated and policy makers push for better alignment of incentives. The

changes could intensify competition among PBMs on transparency and net drug costs,

according to the article’s authors, while also accelerating the rise of direct-to-consumer

drug purchasing models that may reduce PBM’s role in the pharmaceutical supply chain.

(Inside Health Policy, Gabrielle Wanneh, 5/15/26)

General News Scrape

A Minnesota • (MN) - House Passes Bill To Expand Medicaid Fraud Investigation Unit:

House of Representatives bill aimed at strengthening Medicaid fraud enforcement passed

the House and now moves to the Senate. The legislation would provide about $1.23M

annually from FY2027-2029 to expand the Attorney General’s Medicaid fraud unit, with

significant federal matching funds. The bill also broadens the definition of Medicaid fraud