Month: July 2025

Posted on in Data Stories

How a Weighted H-1B Selection Process Might Affect Young International Journalists?

The Trump administration recently revealed plans to significantly change the way H-1B work visas are awarded. These visas, reserved for foreign workers with specialized skills, are often a critical pathway for young international professionals, including journalists, to launch their careers.

Under the current system, most H-1B applicants must go through a lottery conducted by U.S. Citizenship and Immigration Services (USCIS) when the number of applications exceeds the annual cap: 65,000 for general applicants and an additional 20,000 for those with advanced degrees. But according to a recent filing from the Office of Information and Regulatory Affairs, the Department of Homeland Security (DHS) is now considering replacing the random lottery with a “weighted selection process” based on salary.

This idea echoes a final rule published by the DHS in 2021, in which USCIS proposed to rank and select applicants by wage level, starting with the highest (OES Wage Level IV) and working down to the lowest (Level I). Under this model, applicants offering higher salaries would be prioritized for selection.

It remains unclear how a salary-based selection process would account for disparities across occupations and regions, where prevailing wages can differ dramatically. For example, a Level 1 wage for a junior computer programmer in Silicon Valley is $102,877, significantly higher than the $98,613 salary of a Level 3 journalist, who is expected to have several years of experience. This discrepancy suggests that even highly qualified journalists could be ranked below entry-level peers in other, higher-compensated fields.

And what does a salary-based selection mean for young international journalists, if competition from other occupations is set aside?

Typically, recent international graduates started their careers with a Level I or Level II salary, as indicated on their labor condition applications. To qualify for a Level II Wage, young journalists working in New Jersey, New York, the District of Columbia, Maryland and Virginia, where most media job opportunities are concentrated, must earn salaries exceeding $100,000 annually, according to my analysis of U.S. Department of Labor OFLC Wage data. In contrast, journalists in states such as Kansas, Kentucky and West Virginia can meet the Level II threshold with salaries under $30,000.

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Posted on in CMS Data Highlights, Data Stories

Providers Are Winning More Surprise Billing Disputes Than Ever

HaloMD, a third-party independent dispute resolution services provider, has emerged as the top “middleman” under the No Surprises Act. Its share of initiating disputes jumped from just 1% in 2023 to 18% by the fourth quarter of 2024, an analysis of new CMS data found.

The No Surprises Act, passed in 2021, banned the practice of billing patients for the difference between what their insurer pays and what a provider charges when patients unknowingly receive care from an out-of-network provider. The law also established a federal IDR process that out-of-network providers and insurers can use to determine the OON rate that providers should receive if the two parties fail in their own attempts to negotiate. 

In 2024, a total of 1,419,634 surprise billing disputes were initiated through the federal IDR process, a 116% increase from 2023. More than 86% of those cases were filed by provider groups, according to an analysis of CMS data on emergency and non-emergency services (excluding air ambulance services). Among resolved disputes, provider groups won the majority, with their win rate rising from 68% in the first quarter of 2023 to 86% in the fourth quarter of 2024.

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During IDR, providers submit unresolved bills to an HHS-approved arbitrator, who then selects an amount submitted by either the payer or the provider using criteria laid out by HHS. The arbitrators are obliged to consider the qualifying payment amount (QPA) — based largely on median regional in-network rates for a service in a given area — in their decisions. 

The majority of surprise billing disputes were initiated by a small number of providers or their representatives, an analysis of CMS data shows. The top initiating parties over the past two years — Team Health, Radiology Partners and SCP Health — represent thousands of clinicians across multiple states and are all backed by private equity. 

Although HaloMD ranked fourth overall in volume, it became the top initiating party in the fourth quarter of 2024. The third-party IDR services provider, with a win rate of more than 85% in 2024, is now facing lawsuits alleging abuse of the system. In May, Elevance, Inc.’s Georgia subsidiary sued the company and three Georgia providers, accusing them of falsely attesting to claim eligibility, overwhelming the IDR process and inflating payment offers. A month later, Elevance’s Ohio subsidiary, Community Insurance Company, made similar allegations against HaloMD and five providers in Ohio. 

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Neurology, surgery and radiology providers using the IDR system won at especially higher prevailing rates. In 2024, the median payment determination among disputes involving neurology and neuromuscular procedures was more than 11 times the QPA. For surgeries, the median prevailing offer reached nearly 870% of the QPA.

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But why did providers win surprise billing disputes so often? A KFF analysis suggested that providers’ high win rate in IDR cases may stem from how decision-makers weigh insurer-submitted QPAs against providers’ evidence like prior contracted rates, especially since private equity-backed groups often had higher past rates and filed many disputes. The analysis also noted that the high win rate incentivizes well-resourced specialty providers to remain out-of-network, since they can absorb the costs and delays of the IDR process and recover expenses by setting higher prices.

Posted on in CMS Data Highlights, Medicare

Provision in Final Reconciliation Bill Could Exempt More Drugs from Medicare Price Negotiations

A reintroduced provision in the final version of the One Big Beautiful Bill Act could allow more medications to sidestep Medicare drug price negotiations under the Inflation Reduction Act.

The measure, known as the Orphan Cures Act, broadens the exemption criteria for orphan drugs. Currently, the exemption only applies to orphan drugs designated for only one rare condition and approved for an indication (or indications) only for that condition. The provision expands that exemption to drugs with multiple rare disease indications.

Had the Act been passed earlier, two drugs with high gross Medicare Part D spending would be exempted in the first two rounds of negotiation: Pharmacyclics LLC’s Imbruvica (ibrutinib) and Bristol Myers Squibb’s Pomalyst (pomalidomide).

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Four medications with orphan designations granted by FDA are likely to be selected for Medicare negotiation in 2028, according to a study published in the Journal of Managed Care & Specialty Pharmacy. Together, those drugs generated more than $10.8 billion in Medicare spending in 2023, according to CMS data.

Among them are two high-cost Part B oncology drugs:

  • Merck’s Keytruda (pembrolizumab), the world’s best-selling cancer drug in 2024, has received 12 orphan designations and over 40 FDA approvals for various cancer types. Merck noted in its annual SEC filing that it expects U.S. sales of Keytruda to decline starting in 2028 due to the Medicare negotiation program.
  • Bristol Myers Squibb’s Opdivo (nivolumab), a top-selling immunotherapy drug.

Another two Part D drugs with orphan designations that might be included in the negotiation list are:

  • Gilead’s Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide), a small-molecule HIV drug with $3.1 billion in Medicare Part D spending in 2023.
  • Mallinckrodt’s Acthar (corticotropin), often prescribed for a range of autoimmune and inflammatory conditions.

While a Trump-era executive order sought to extend the negotiation exemption for new small-molecule drugs — a move to adjust the so-called “pill penalty” — that provision was left out of the final act.

In its latest draft guidance for the third round of Medicare drug price negotiations, CMS said it will announce the 2028 negotiation list by Feb. 1, 2026, with negotiated prices taking effect on Jan. 1, 2028. The agency also signaled it may revisit pricing for drugs already negotiated for 2026 or 2027.

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The Orphan Cures Act has received strong backing from the pharmaceutical industry, which argues that it will encourage more investment in rare disease treatments. According to OpenSecrets, 26 pharmaceutical companies and organizations have registered to lobby on the bill. After being omitted from an earlier version, the provision was reinstated in the final One Big Beautiful Bill Act package.

The Congressional Budget Office (CBO) estimates that the orphan drug exemption will yield $5 billion in industry savings over the next decade.

Meanwhile, pharmaceutical lobbying is surging. Industry giants like Sanofi, Pfizer, and Johnson & Johnson significantly boosted their lobbying expenditures in the first quarter of 2025. PhRMA, the industry’s main lobbying group, spent nearly $13 million, a 33% increase from the same quarter in 2024, making it the top lobbying spender in the drug industry and the second-largest overall.

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