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  • Probing the Legal Arguments in the Drug Industry’s Challenges to Medicare Drug Price Negotiations

    Event Date:
    Event

    With the Biden administration’s announcement of the first 10 drugs to be negotiated for Medicare as part of the Inflation Reduction Act (IRA), an array of legal challenges from the pharmaceutical industry is potentially the biggest obstacle to implementation. On Tuesday, September 12, two legal experts and a health policy expert joined Larry Levitt, executive vice president for health policy at KFF, for a 45-minute discussion about the legal issues underpinning these lawsuits and how they intersect with the policy goals of the legislation.

  • What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid

    Issue Brief

    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.

  • The Impact of H.R. 1 on Two Medicaid Eligibility Rules

    Issue Brief

    This issue brief describes the impact of H.R.1's 10-year delay in implementing provisions in two Medicaid eligibility rules that would have reduced red tape. The delayed rules are projected to decrease federal spending and future Medicaid and CHIP enrollment and increase coverage loss.

  • The IRA Has Improved Coverage of Drugs Selected for Medicare Price Negotiation

    Issue Brief

    The Medicare drug price negotiation program could improve coverage of drugs selected for negotiation for Medicare beneficiaries because the law requires all Medicare Part D plans to cover each of the selected drugs, including all dosages and forms, when negotiated prices take effect.
    This analysis examines 2026 Medicare Part D formulary coverage of drugs selected for negotiation to measure the effect of the IRA's coverage requirement.

  • Analyzing Changes in Medicare Part D Enrollment for 2026

    Issue Brief

    The Medicare Part D prescription drug benefit is provided by private plans, either Medicare Advantage plans that offer drug coverage (MA-PDs) or, for those in traditional Medicare, stand-alone prescription drug plans (PDPs). New data from CMS shows that 56 million people are enrolled in Part D plans as of February 2026, with more in MA-PDs than PDPs, reflecting higher overall enrollment in Medicare Advantage than in traditional Medicare. Enrollment in group MA-PD plans decreased while group PDP enrollment increased.