RISE summarizes recent regulatory-related headlines and reports.
Humana: 20% of MA members currently enrolled in 4-Star plans for 2026
Humana, the second largest provider of Medicare Advantage (MA) plans in the United States, said in a Securities and Exchange Commission filing this week that approximately 1.2 million or 20 percent of its members are currently enrolled in plans rated 4 Stars and above for 2026, with an average Star rating of 3.61, consistent with the Company’s 2025 average MA Star Rating. The Company also has 14 percent of members in 4.5 Star plans in 2026, up from 3 percent in 2025.
Humana announced the ratings based on 2026 MA Star ratings data that the Centers for Medicare & Medicaid Services (CMS) inadvertently made accessible on the CMS Plan Finder on October 1.
In a press release, Humana said that in 2026, 80 percent of MA members will be in plans with stable benefits, including preventive and diagnostic screenings for breast cancer, colon cancer, and bone density at no additional cost. All of the MA plans include dental, vision, and hearing supplemental benefits. The company said it will offer MA plans in 46 states and the District of Columbia, covering 85 percent of U.S. counties.
The company also said in the securities filing that it is working on a MA contract diversification strategy and expects that the percentage of members enrolled in contracts rated 4 Stars or above in 2027 will be meaningfully higher than the 20 percent enrolled in 2026.
President Trump launches plan with Pfizer to lower drug costs
President Donald Trump this week announced a deal with Pfizer to sell drugs at lower prices. In a fact sheet, the White House said the agreement will provide every state Medicaid program in the country with access to lower drug prices on Pfizer products. The agreement requires Pfizer to offer medicines at a deep discount off the list price when selling directly to American patients.
The discounted drugs will be offered via a website called TrumpRx.gov, which will be operated by the federal government, NPR reported. The website will launch at some point in 2025 and would take consumers to pharmaceutical companies’ direct-to-consumer websites to fulfill orders, the publication said. The website deals would be available to patients who do not use their health insurance, sources told NPR.
In a press release, Pfizer announced that most of the company’s primary care treatments and some select specialty brands will be offered at savings that will range as high as 85 percent and on average 50 percent. Specific terms of the agreement remain confidential, the company said.
CMS issues final guidance for Medicare drug price negotiations
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) on Tuesday released final guidance for the third cycle of negotiations under the Medicare Drug Price Negotiation Program.
The guidance incorporates public feedback on policy, particularly on increasing transparency, and implements expanded protections for orphan drugs enacted in the Working Families Tax Cuts Act.
The guidance addresses enhanced orphan drug protections, incorporates Medicare Advantage encounter data along with traditional fee-for-service claims into total expenditure calculations, and how it will identify and consider vaccines for infectious diseases in the negotiation process.
“CMS is working to lower health care and prescription drug costs for Americans while ensuring the negotiation process is open, fair, and responsive to changes in the market and patient needs,” said CMS Administrator Dr. Mehmet Oz in the announcement. “We've listened to stakeholders, and their feedback helped us make the Negotiation Program more transparent, more workable for manufacturers, and more responsive to the needs of Medicare beneficiaries.”
The agency said the third cycle of negotiations will occur in 2026, with negotiated maximum fair prices (taking effect on January 1, 2028. CMS will announce up to 15 additional drugs covered under Part D and/or payable under Part B for potential negotiation by February 1, 2026, plus any additional drugs selected for the first cycle of renegotiation.