Nearly the entire Medicare Advantage (MA) market in Vermont disappeared this year. It’s an unusually extreme example of an emerging nationwide trend.

Though companies enter and exit the MA game all the time, disenrollments are spiking as MA providers reduce benefits and leave less profitable markets (minus special needs plans, of course) in response to rising medical expenses and increased federal scrutiny and limits.

As a result, about 92% of Vermont’s MA enrollees were forcibly disenrolled after insurers exited their county, per a Feb. 18 JAMA research letter.

Nationally, an average of 10% of beneficiaries in HMO and PPO plans (2.9 million) were forcibly disenrolled and left with the option of joining another MA plan if one was available or enrolling in traditional fee-for-service Medicare. In 2025, it was 7%. Prior to that from 2018–2024 it averaged 1%.

This spike in disenrollments is one of the “trade-offs” to policies that reduce payments to MA providers, Mark Meiselbach, the research letter’s coauthor and health economist at Johns Hopkins Bloomberg School of Public Health, told us.

Could this be a sign of things to come?—CC

After spending nearly seven years at Big 3 pharmacy benefit manager (PBM) CVS Caremark, pharmacy industry veteran Ritu Malhotra recently joined a brand-new alternative PBM, Illuminate Rx, as president.

Illuminate Rx, which launched on Sept. 10, 2025, is an affiliate of RxBenefits, a pharmacy benefits optimization company founded in 1995.

What makes it different from the standard PBM, according to Malhotra, is Illuminate Rx is “very clear” about where its money comes from: an administrative fee “that captures all of the costs associated with administering the plan.”

“What that allows for is a level of flexibility and customization that just doesn’t really happen at the bigger PBMs because they’re taking risk in a different way,” she said.

The PBM is also unique in the fact that it employs a large portion of clinicians relative to the company’s overall size, Malhotra added.

“I was shocked when I found that out,” she said. “We’re putting the clinical focus back into pharmacy benefits. So much of it was about cost for so long, with prior authorizations and other clinical programs really just being barriers to care as opposed to having a clinical point of view.”

Here’s what she thinks about the state of the industry.—MA

Paging all healthcare professionals: Welcome to Recall Roundup, where we keep you updated on some of the most serious FDA medical device recalls from the last month.

Recalls range from making tweaks to pulling a device from the market altogether. First, the manufacturer takes action, then the FDA decides whether that action should be labeled a recall. The recalls are ranked from Class III (least dangerous) to Class I (most dangerous).

Let’s get into it.

Feeling pressure. Olympus sent a Jan. 16 letter warning customers to stop using certain models of its high-flow insufflation unit. The units’ software has an algorithm that could cause overpressure, which can lead to air embolisms, cardiac arrest, or death. As of Dec. 31, Olympus has reported two serious injuries but no deaths related to this issue.

See the full list here.—CC

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• Internal Medicine GME Junior Faculty 4th Year Chief Resident at HCA Florida Citrus Hospital
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• Chief Nursing Officer at New England Rehabilitation Hospital
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