For how we live.
A $7.9 billion program now pays practices an additional 12.5% on top of the standard Medicare rebate for every bulk-billed visit — split evenly between the clinic and the doctor who sees the patient.
Tirzepatide has been approved for obstructive sleep apnea since December 2024. A January 2026 reanalysis of the trial behind that approval separates what weight loss fixed from what treating the breathing fixed.
The pandemic-era rules letting Medicare patients see a doctor from home, anywhere in the country, are now locked in through the end of 2027 — the longest extension since they were created.
The public comment window just closed on a proposal that would govern how up to 20 high-cost drugs a year get their Medicare prices negotiated, starting with prices that take effect in 2029.
Physician surveys report delays and abandoned treatment; those are self-reported. A harder number: a federal audit found 13% of Medicare Advantage denials met Medicare's own coverage rules.
For many older generics, discount cards and cost-plus pharmacies undercut insured prices. One analysis found Medicare could have saved $3.6 billion on 77 generics buying at cash-plus prices.
Medicare's cap is statutory; the commercial version is a voluntary manufacturer promise with conditions. Before the caps, 1.3 million adults rationed insulin because of cost.
The prices apply only to 10 drugs, only in Medicare, and only from January 2026. Here is exactly which drugs, by how much, and who actually sees the difference.
Across all drugs, US prices are 2.78 times those in 33 other wealthy countries. The gap is not that Americans use more medicine — it is that no one sets the launch price.
A study of 1.8 million Medicare beneficiaries found vaginal estrogen prescriptions went unfilled by the overwhelming majority — and were least likely of all in women with recurrent urinary tract infections.
The WISeR model starts on 1 January in six states. The contractors running it are paid out of the savings their determinations produce — the design feature doctors keep pointing at.