Australian Healthcare: Healthcare Daily: News, research & industry feedback

Research evidence excerpt

Australian Healthcare: Healthcare Daily: News, research & industry feedback

Global Research

16 June 2026ab

Australian Healthcare Equities

AustraliaHealthcare Daily: News, research & industry

feedback Healthcare

David Low

Analyst

david.low@ubs.com

Stocks covered: COH, CSL, SHL +61-2-9324 2843

James Meares

Industry feedback Analyst

james.meares@ubs.com

+61-29-324 3575COH/CSL - US Medicare & Medicare Advantage Landscape (15 Jun)

Grace Allen

Associate Analyst

We hosted a call with an expert on the US payer landscape. The call focussed on US

grace-za.allen@ubs.com

Medicare including Medicare Advantage and the implications for cochlear implants. We +61-2-9324 2000

also touched on the CSL focussed topics including the 340b Drug Pricing Program and

rare disease coverage.

Medicare coverage is roughly balanced between FFS and MA. Traditional

Fee-For-Service represents ~48% of coverage versus ~52% for Medicare

Advantage, with ~90% of beneficiaries qualifying at age 65+ and ~10% via

disability.

MA profitability decline explains tightened access. From 2018–2023, for-

profit MA plans generated attractive returns through favourable risk scoring and

Stars incentives, but CMS reforms in 2024–25 curtailed these economics, leading

to losses. The industry responded with premium increases and tightened access,

via the use of prior authorisation and network restrictions.

Administrative friction is the primary lever for restricting access. Payors can

introduce additional steps and complexity, which likely deters some patients and

clinicians, but cannot fundamentally deny coverage where criteria are met.

Cochlear implant access protected under NCD. The national coverage

determination is highly prescriptive, limiting the ability of MA plans to restrict

access beyond administrative hurdles.