MA Growth Slows, ACA’s Red State Surge, & FTC Pauses PBM Action

Hey all,

Hope you’ve had a great week so far! I was disappointed to see the FTC pausing their case against the PBMs since I am a T1 diabetes patient who takes insulin. Hopefully this is a case that the FTC will take up once new commissioners are appointed. Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Chartis) 2025 Medicare Advantage competitive enrollment report

Medicare Advantage (MA) enrollment growth slowed to 3.9% in 2025—down from 7% in prior years—as rising costs, benefit cuts, regulatory scrutiny, and market exits created a “perfect storm” of challenges for health plans. While growth decelerated, the MA market still reached 34.5 million enrollees, driven in part by consumer preference and continued expansion of Special Needs Plans (SNPs), with for-profit insurers maintaining dominance despite increased gains by nonprofit and Blues plans. Declining plan quality, reduced Star Ratings, and fewer plan choices add further complexity, and many MA plans have responded by exiting select markets, reducing service areas, or terminating underperforming products to stabilize operations. Full Article.

(KFF) and ACA Marketplace Enrollment Growth 2020–2025

ACA Marketplace enrollment hit a record 24.3 million in 2025, more than doubling since 2020 largely due to enhanced subsidies introduced by the American Rescue Plan and extended by the Inflation Reduction Act. The most dramatic growth occurred in Republican-leaning states—like Texas (255%), Mississippi (242%), and Georgia (227%)—which had higher uninsured rates and often did not expand Medicaid, while a few Democratic-leaning states like New York and Oregon saw slight declines due to alternative public health coverage options. As enhanced subsidies are set to expire at the end of 2025, millions could lose coverage unless Congress acts to renew them. Full Article

(Modern Healthcare) FTC Pauses Case Against Major PBMs

The Federal Trade Commission has paused its case against CVS Caremark, Express Scripts, and OptumRx, which alleges the companies used rebate schemes to inflate insulin prices. The administrative proceeding is on hold for at least 105 days due to the lack of participating commissioners, following recent resignations and dismissals. A new hearing date will be set 225 days after the stay is lifted. Full Article