Insurance & Benefit Design
Expert articles and analysis related to insurance & benefit design.
AI Summary â Last 30 Days
Over the past 30 days, CMS has issued key updates that reinforce the emphasis on benefit design, transparency, and administrative reform in government-sponsored insuranceâparticularly Medicare Advantage (MA). The finalized CY 2027 MA Rate Notice yields a 2.48% average increase in plan payments, signaling CMSâs effort to stabilize MA growth while responding to sustained criticisms around cost pressures and margins, especially in the context of value-based arrangements and provider networks.
Related Articles
Payers need to speed up prior authorization for drugs under proposed rule
Health insurers face a prior authorization prescription drug mandate similar to the rule imposed on claims, under a proposal released Friday by the Centers for Medicare & Medicaid Services.CMS is prop...
CMS proposes new deadlines for prior authorizations for drugs
Drugs were left out of a 2024 rule streamlining prior authorizations by making decisions electronic and requiring payers to turn them around more quickly. The Trump administration is looking to addres...
How CVS Caremark is using innovative technology to simplify the prior authorization process
How CVS Caremark is using innovative technology to simplify the prior authorization process  Fierce Healthcare
Administrative burden is driving severe physician burnout
You trained for years to become a physician so you could heal people. Yet every day, you find yourself fighting the very system that is supposed to support you. A patient presents with classic symptom...
CMS proposes easing prior authorizations for prescription drugs
CMS proposes easing prior authorizations for prescription drugs  Modern Healthcare
CMS releases proposed rule establishing electronic standards for drug prior authorizations
CMS releases proposed rule establishing electronic standards for drug prior authorizations  American Hospital Association
Prior authorization by the numbers: 10 stats that show the strain
A 2024 CMS rule now requires payers, including Medicare Advantage plans, Medicaid, CHIP and ACA exchange carriers, to publicly report prior authorization metrics for the first time. The public report...
Insurers have Cut Prior Auth by 11% Following Commitments
Insurers have Cut Prior Auth by 11% Following Commitments  MedCity News
Insurers Cut 11% of Prior Authorizations, Expand Continuity-of-Care Protections
Insurers have cut prior auth requirements by 11%: AHIP-BCBS
Insurers have cut prior auth requirements by 11%: AHIP-BCBSÂ Â Becker's Hospital Review