V-BID Update: WISeR Moves Forward, Insulin Bill Advances, and Rising Cost Pressures

In this Issue:

• Senate Rejects Resolution to Block CMS WISeR Prior Authorization Model
• Senate Committee Advances Bipartisan $35 Insulin Cap Bill
• Medicare to End Part D Premium Stabilization Program After 2026
• Federal Housing Assistance Linked to Improved Cancer Treatment and Survival
• Most HSA Holders Use Accounts for Current Healthcare Expenses
• Fidelity Estimates Retirees Will Need $185,500 for Healthcare
• Study Finds Persistent Financial Burden for Adults With Vision Impairment
• Hospital Prices Drive More Healthcare Spending Than Drug Prices

Senate Rejects Resolution to Block CMS WISeR Prior Authorization Model

The Senate voted 50-46 against a resolution to overturn the CMS WISeR model, allowing the Medicare demonstration to move forward. The model uses AI-assisted prior authorization to review select services in Traditional Medicare as part of an effort to reduce waste and low-value care. The vote preserves the six-state pilot despite continued debate over patient access, prior authorization, and the use of AI in Medicare coverage decisions.

Senate Committee Advances Bipartisan $35 Insulin Cap Bill

A bipartisan Senate committee approved the INSULIN Act of 2026, advancing legislation that would cap monthly out-of-pocket insulin costs at $35 for people with private and employer-sponsored insurance. The bill would also establish a pilot program to provide insulin at the same cost for uninsured individuals. The measure now heads to the full Senate for consideration.

Medicare to End Part D Premium Stabilization Program After 2026

CMS will end its temporary Medicare Part D premium stabilization demonstration after 2026, a program that helped limit premium increases as the redesigned drug benefit was implemented. While most beneficiaries are expected to see modest premium changes, some standalone Part D plans could experience larger increases beginning in 2027. The change has raised concerns that higher prescription drug premiums could encourage more beneficiaries to enroll in Medicare Advantage plans that include drug coverage.

Federal Housing Assistance Linked to Improved Cancer Treatment and Survival

A JAMA Network Open research letter found that older adults with non-small cell lung cancer who received federal housing assistance were more likely to receive recommended treatment and had better survival outcomes than similar patients without housing assistance. The findings suggest that housing stability may improve access to cancer care and support better health outcomes for Medicare beneficiaries.

Most HSA Holders Use Accounts for Current Healthcare Expenses

A new EBRI analysis found that most health savings account (HSA) holders use their accounts to pay for current medical expenses rather than saving for future healthcare costs. Employer contributions were the most common reason for opening an HSA, while only about three in ten accountholders viewed their HSA primarily as a long-term investment. The findings suggest that, despite their long-term tax advantages, HSAs are most often used as a tool to manage immediate healthcare expenses.

Fidelity Estimates Retirees Will Need $185,500 for Healthcare

Fidelity estimates that a 65-year-old retiring in 2026 will need $185,500 to cover healthcare expenses throughout retirement, a 7.5% increase from last year and the largest annual jump in more than a decade. The estimate reflects rising healthcare prices, greater use of medical services, and increasing costs associated with chronic conditions. It excludes long-term care expenses, underscoring the importance of planning for healthcare costs beyond Medicare coverage.

Study Finds Persistent Financial Burden for Adults With Vision Impairment

A new JAMA Network Open study found that insurance coverage improved for working-age adults with vision impairment between 2014 and 2024, driven largely by increased Medicaid enrollment. Despite these gains, adults with vision impairment remained more than twice as likely as those without vision impairment to spend at least 10% of their family income on out-of-pocket healthcare costs. The findings suggest that expanded insurance coverage has not eliminated the disproportionate financial burden faced by people with vision impairment.

Hospital Prices Drive More Healthcare Spending Than Drug Prices

A new KFF perspective published in JAMA Health Forum argues that while high drug prices receive significant public and political attention, hospital prices are a larger driver of overall healthcare spending growth. The analysis notes that prices paid by private insurers to hospitals average more than 2.5 times Medicare rates and vary widely across markets, suggesting opportunities for cost containment. The perspective suggests addressing hospital pricing will be essential to meaningfully reduce national healthcare spending.

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