Medicaid is the primary program providing comprehensive health and long-term care to low-income people, including access to prescription drugs to treat acute problems and manage ongoing chronic conditions, covering about one in five people in the United States. In recent years, Medicaid spending on prescription drugs has grown substantially, in part due to the emergence of new, high-cost drugs, including GLP-1s and cell and gene therapies that treat, and sometimes cure, rare diseases.

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After years of rapid increases, Medicare Advantage enrollment growth slowed in 2025, a trend that continued in 2026. The number of Medicare Advantage prescription drug (MA-PD) plans available to the average Medicare beneficiary has declined from a peak of 36 in 2024 to 32 in 2026. Additionally, the trend of rapidly expanding extra benefits, spurred by sharp increases in rebate payments from the federal government, has stalled, with a smaller share of plans offering over-the-counter allowances and meals after hospital stays. Medicare Advantage insurers have warned that recent changes to the Medicare Advantage payment system have already hurt enrollees, leading to plan terminations, reduced benefits, and higher costs, and that these harmful effects will be exacerbated if the Trump Administration’s proposed payment rates for the 2027 plan year are finalized.

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If you judged by the more than 16,400 comments posted on a federal government website, you’d think there was a groundswell of older Americans demanding that federal officials hike payments to their Medicare Advantage health insurance plans. 

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In recent years, Medicaid spending on prescription drugs has grown, in part due to the emergence of new, high-cost drugs, including GLP-1s and cell and gene therapies that treat, and sometimes cure, rare diseases. There have been several recent Trump administration prescription drug initiatives (Box 1), including new payment models, that could help combat rising costs for state Medicaid programs, though questions remain about the implementation and impact of the deals. While lower prices for state Medicaid programs through the new models could result in reduced Medicaid prescription drug spending and potentially expanded coverage of certain drugs, the extent of the savings and how states or manufacturers will respond remain unclear. In most cases, Medicaid programs already pay lower prices, net of rebates, than other payers.

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Western Massachusetts, a patchwork of rural communities and low-income cities, is a difficult place to find a primary care doctor if you don’t already have one. Frustrated patients often turn to online forums, asking for leads or advice on how to find a practice that is accepting new patients.

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Editorial Note: This brief was updated in March 2026 to reflect the results of the second round of Medicare drug price negotiation and details about the third cycle of the negotiation program, including the list of drugs selected for negotiation in early 2026.

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Editorial Note: Originally published on September 27, 2024, this brief was updated on March 10, 2026 to incorporate new federal policy developments on contraceptive coverage.

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Eight-year-old Jonah woke up one May morning with a swollen face and a toothache. He refused the pain medication that his mom, Geneva Reynolds, tried to give him. He didn’t sleep or eat and cried constantly.

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The Centers for Medicare & Medicaid Services (CMS) has released a memo fleshing out the design of a short-term program providing Medicare coverage of GLP-1s for obesity in 2026 ahead of a multi-year demonstration program beginning in 2027. Medicare is statutorily prohibited from covering drugs used for weight loss, and these demonstration programs are designed to fill that gap.

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In December, Nebraska was the first state to announce that it would be enforcing Medicaid work requirements early, starting May 1, 2026. The 2025 reconciliation law requires states to condition Medicaid eligibility for adults in the ACA Medicaid expansion group and enrollees in partial expansion waiver programs (Georgia and Wisconsin) on meeting work requirements starting January 1, 2027; however, states have the option to implement requirements sooner through a state plan amendment (as is the case for Nebraska) or through an approved 1115 waiver.

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