PBM Giant Vows to Stop One Sketchy Practice (Stay Tuned for the Next One), CMS Scrambles to Staff Up After Shutting Down, and ACA Premiums Prepare to Jump 30%

Hey all,

Today's theme: announcing you're fixing the problem is much easier than actually fixing it. Whether it's PBMs eliminating rebates while surely not finding alternative revenue streams, or recalling furloughed workers to prevent Medicare enrollment chaos we created ourselves, the healthcare system excels at solving problems it invented in the first place. At least we're consistent—consistently addressing symptoms while the underlying dysfunction prints money.

Enjoy the rundown!

Jacob Brody (Co-founder and CEO, ZorroRX) 

(Endpoints News) and (Cigna to End Drug Rebates by 2027):
Cigna announced it will eliminate drug rebates starting in 2027, shifting to upfront discounts for insured patients and a new pricing model by 2028 that guarantees consumers the lowest cost for branded and generic medications. This move targets growing criticism of pharmacy benefit managers (PBMs) like Express Scripts—owned by Cigna—whose rebate practices are blamed for inflating drug prices, despite uncertainty about how this shift will impact overall costs. Anyone who wants to bet on Cigna finding a way to make the money back on the backend, feel free to reach out. Full Article.

(BenefitsPRO) and (CMS Recalls Furloughed Workers for Health Insurance Enrollment): The Centers for Medicare & Medicaid Services (CMS) is recalling about 3,000 furloughed employees to ensure the timely rollout of open enrollment for health insurance amid an ongoing government shutdown. With nearly half of CMS's workforce initially furloughed and broader disruptions hitting the health care system—including halted Medicare telehealth services and looming ACA premium hikes—the agency is using user fee funds to temporarily restore key staffing needed for enrollment support. If there’s one way to instantly frustrate an important national constituency, it’s failing to staff up for Medicare open enrollment—because few things unite people across the political spectrum like not messing with seniors’ health coverage. Full Article

(Washington Post) Average ACA Premiums Set for 30% Spike

ACA marketplace premiums are set to rise by an average of 30% in 2026, the steepest increase in years, according to CMS data reviewed by The Washington Post. The spike comes as enhanced premium tax credits—originally introduced during the pandemic—are set to expire, amid political deadlock over their extension during a broader government shutdown. We could either throw money at a broken system or push for real reform—but let’s be honest, we’re probably just going to keep throwing money. Full Article