Wednesday, June 3, 2026

Cigna stopped covering GLP-1 drugs like Wegovy and Zepbound for weight loss for its own U.S. employees starting June 1. The company cited unsustainable costs, with over 10% of its U.S. staff using the medications. This mirrors a broader employer trend of scaling back coverage for high-cost obesity therapies. For practices, this signals tighter payer scrutiny on GLP-1 claims and potential increases in patient out-of-pocket costs for these drugs. Monitor Cigna's public-facing commercial plan policies for similar exclusions; self-funded employer plans may follow Cigna's lead.

Eli Lilly notified hospitals in the 340B drug discount program they must submit claims-level data for all 340B-purchased medicines or lose discounts starting October 1, 2026. The demand, referenced in signal 106, aims to enforce a federal appellate ruling allowing manufacturers to impose conditions on 340B contract pharmacies. Affected hospitals have a 90-day window to comply. Billing teams at 340B entities must coordinate with pharmacy and compliance staff immediately to audit data-sharing capabilities and assess the operational and financial impact of the mandate.

The Federal Trade Commission mandated Ascension divest two ambulatory surgery centers in Michigan and one in Indiana as a condition of its $3.9 billion acquisition of AmSurg. The consent order aims to preserve competition in those local markets. The deal, which combines Ascension's 140-hospital system with AmSurg's 250-plus surgery centers, will reshape outpatient surgical service networks. For independent practices, this consolidation may alter local referral patterns and contracting leverage with the newly enlarged entity. No immediate billing changes are required, but monitor for network announcements.

CMS finalized guidance for the 2027 Medicaid work requirements mandated by the 2025 Reconciliation Law. The rule adopts a more restrictive definition of 'medical frailty,' narrowing which beneficiaries qualify for an exemption. This change increases the likelihood of disenrollment for high-risk, high-cost patients who cannot meet the 80-hour monthly work requirement. State implementation will drive patient churn and shift uncompensated care burdens. Monitor your state's 1115 waiver applications and plan for potential front-desk confusion as patients navigate new reporting rules next year.

CMS released an interim final rule for Medicaid work requirements. Major health associations, including the American Medical Association, oppose the policy, warning it will strip coverage from millions of low-income adults. The rule allows states to begin implementing work and community-engagement mandates for non-elderly, non-disabled adults starting in 2027. This policy shift will reshape the safety net, potentially increasing uninsured volumes in states that adopt the requirements and shifting financial risk to providers. The comment period is open, but the administration's stance indicates the rule will proceed.