The Health Policy War Room

Medicare Insights

My most recent insights on the state of health policy in the U.S. and how it is impacting the pharmaceutical, medical technology and clinical diagnostics industries

Medicare Insights<br />
Centers for Medicare & Medicaid Services

KFF Health Tracking Poll: Balancing Efficiency and Public Sentiment

As federal healthcare spending comes under scrutiny amid calls for broader fiscal responsibility, findings from the January 2025 KFF Health Tracking Poll shed light on Americans’ priorities. This moment presents a dual challenge for the Administration: aligning its...

Understanding Genetic Testing for Hereditary Cancers: Empowering Personalized Care

The 2025 NCCN Guidelines for Patients highlight the critical role of genetic testing in managing hereditary cancers like breast, ovarian, pancreatic, and prostate cancers. The guidelines emphasize early identification of pathogenic gene variants to enable personalized screening, preventive surgeries, or targeted treatments like PARP inhibitors. They advocate for pre-test counseling, multi-gene panel testing, and tailored follow-up care based on patient history and familial risk. For payers, this shift encourages reconsideration of restrictive policies that exclude testing for asymptomatic individuals, aligning with preventive healthcare goals. Developers of genetic tests can leverage these recommendations to support coverage and reimbursement by demonstrating clinical utility and economic value.

TCET — Navigating Medicare’s Transitional Coverage for Emerging Technologies Policy: A Roadmap for Success

For medical device manufacturers, securing Medicare coverage is a critical milestone, yet navigating the complexities of the coverage determination process has long been a challenge. With the introduction of Medicare’s Transitional Coverage for Emerging Technologies...

Understanding Genetic Testing for Hereditary Cancers: Empowering Personalized Care

The 2025 NCCN Guidelines for Patients highlight the critical role of genetic testing in managing hereditary cancers like breast, ovarian, pancreatic, and prostate cancers. The guidelines emphasize early identification of pathogenic gene variants to enable personalized screening, preventive surgeries, or targeted treatments like PARP inhibitors. They advocate for pre-test counseling, multi-gene panel testing, and tailored follow-up care based on patient history and familial risk. For payers, this shift encourages reconsideration of restrictive policies that exclude testing for asymptomatic individuals, aligning with preventive healthcare goals. Developers of genetic tests can leverage these recommendations to support coverage and reimbursement by demonstrating clinical utility and economic value.

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Medicare Advantage Growth vs. Plan Reductions: What It Means for Health Tech Developers

As the Medicare Advantage market continues to evolve, thinking strategically and leveraging the expertise of an experienced consultant can make the difference between a product that flounders and one that thrives. By understanding the landscape, aligning with payer priorities, and planning market entry carefully, health technology developers can navigate the challenges brought on by plan reductions and policy shifts. Consultants provide the insight and experience necessary to turn these challenges into opportunities, ensuring that companies not only survive but succeed in the competitive and ever-changing world of Medicare Advantage.

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Digital Mental Health Treatment: Here Are 4 Fundamentals You Have to Know to Uncomplicate CMS’s Proposed Policy

The Centers for Medicare & Medicaid Services (CMS) recently unveiled a proposal in the 2025 Medicare Physician Fee Schedule to cover Digital Mental Health Treatment (DMHT) devices. This policy marks a significant step towards integrating digital health...

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