Week in Washington

A few bits of potpourri from this week –

CMS Releases Additional ACA Information for 2026 Plan Year

CMS released two items related to the 2026 plan year. It released the 2026 maximum out of pocket (MOOP) figure. For 2026 for self-only coverage the MOOP will be $10,150 or an increase of 10.3% relative to 2025. CMS also released the 2026 Actuarial Value Calculator (you can find the calculator here). As a reminder, this year CMS only released a final calculator and comments on the 2026 AVC will be used for updating the 2027 calculator.

BCBS Lawsuit

Blue Cross Blue Shield Association and its members agreed to a record $2.8 billion settlement over allegations that they suppressed competition and underpaid providers between July 2008 and October of this year. The deal will also allow over 500 hospitals to negotiate new contracts. The vast majority of the settlement will go to providers.

Independent Pharmacies and Medicare Drug Negotiations

According to a recent survey more than half of independent pharmacies are considering not stocking the drugs that were subject to Medicare price negotiations starting in 2026. As part of the structure of the law, pharmacies would have to wait at least a month to receive manufacturer rebates. The lag time could result in fewer pharmacies stocking the drug and less access for consumers. 

Medicare Open Enrollment Starts

Medicare’s annual enrollment period, which runs until December 7 opened this week. CMS projects more than half of Medicare beneficiaries will enroll in Medicare Advantage in 2025 (CMS projected about 35.7 million people will enroll in MA). MA plan offerings are shrinking in about half the states and will likely stay the same or increase in the other half of the states.