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This brief describes current coverage of GLP-1s in Medicare and Medicaid, the Centers for Medicare & Medicaid Services’ (CMS) efforts to expand access and lower costs for GLP-1s through temporary demonstration programs including the BALANCE Model, and potential impacts on beneficiaries and program budgets.
Following the expiration of the enhanced premium tax credits for people with Affordable Care Act (ACA) Marketplace plans, a new KFF follow-up survey of the same Marketplace enrollees KFF surveyed in 2025 finds half (51%) of returning enrollees say their health care costs are “a lot higher” this year compared to last year, including four in ten who specifically say their premiums are “a lot higher.”
To provide context for emerging debates about federal actions to address prescription drug costs, this issue brief highlights five key facts about Medicaid prescription drug coverage, payment, and administration.
This issue brief describes recent trends in the number of Medicaid outpatient prescriptions and the spending on those drugs and examines the implications of recent federal actions on future trends.
This analysis explores trends in how the cost of healthcare affects access to care in the U.S. using National Health Interview Survey (NHIS) data. In 2024, about 1 in 6 adults (17%) reported delaying or not getting healthcare due to cost
This analysis explores the variation in health spending across the population using 2023 Medical Expenditure Panel Survey data. Five percent of the population accounted for nearly half of all health spending in 2023.
States are facing constrained budgets, putting pressure on HIV programs, including the Ryan White HIV/AIDS Program. This Policy Watch explores how state Ryan White AIDS Drug Assistance Programs (ADAPs) are responding to these budget pressures, including by restricting eligibility and reducing the scope of services offered, actions that could led to negative health outcomes for people with HIV and lead to new HIV infections.
In February, the Trump administration launched TrumpRx, a government website that provides prescription drug discounts to consumers. This brief examines issues that may impact consumers, especially those with private insurance, who access drug discounts through TrumpRx.
This brief provides an overview of the role of PBMs in managing pharmacy benefits, discusses federal efforts to reform certain PBM business practices, and explains the estimated federal budgetary impact of the recently enacted legislation, which would be a reduction in the federal deficit of $2.1 billion over 10 years, according to CBO.
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