Payer & Insurance Strategies
Expert articles and analysis related to payer & insurance strategies.
AI Summary — Last 24 Hours
Synthesis:
In the past 24 hours, payer and policy strategies around prior authorization and Medicare programs are intensifying amid both regulatory pressure and innovation. CMS is advancing electronic prior authorization for drugs—phasing out faxes and payer portals—in an effort to streamline access and reduce friction for providers and ACOs, with implications for both medical and pharmacy benefits under a proposed rule published April 14 (HFMA coverage). Meanwhile, bipartisan legislation has been introduced to reform Medicare Advantage, aiming to improve access and care quality, as CMS increases scrutiny—most notably threatening to block enrollment in certain Medicare drug plans for noncompliance, signaling heightened oversight for major payers like Elevance Health (MSN report).
As of April 2025, these actions and announcements are being led by the Trump administration, with CMS Administrator Dr. Mehmet Oz and HHS Secretary Robert F. Kennedy Jr. overseeing these regulatory efforts.
Related Articles
CMS proposes electronic prior authorization for drugs
Amid ongoing implementation of federally required electronic prior authorization for healthcare items and services, CMS now proposes to do the same for pharmaceuticals. New regulations would apply to ...
Rethinking Prior Authorization for Better Outcomes
Rethinking Prior Authorization for Better Outcomes  Fierce Healthcare
New Prior Authorization Proposals: Implications for Prescription Drug Access
New Prior Authorization Proposals: Implications for Prescription Drug Access  Health Affairs
UnitedHealthcare, Aetna, Cigna tout progress to standardize prior authorization as part of industry-wide commitment
UnitedHealthcare, Aetna, Cigna tout progress to standardize prior authorization as part of industry-wide commitment  Fierce Healthcare
Health plans adopt standardized approach to prior authorization
Health plans have announced a new initiative to adopt a standardized approach for electronic prior authorization requests, according to AHIP.The standardized approach will be used for medical services...
Cigna, Humana standardizing some prior authorization requirements
Cigna, Humana standardizing some prior authorization requirements  Modern Healthcare
Medicare AI prior authorization pilot delaying care in Washington: report
The report compiled by Sen. Maria Cantwell, D-Wash., found procedures in the state that were previously approved in two weeks now take four to eight weeks to be authorized.
Health Plans Take Next Step to Streamline and Simplify Prior Authorization for Patients and Providers
Health Plans Take Next Step to Streamline and Simplify Prior Authorization for Patients and Providers  AHIP
‘We want to be known as your best partner’: UnitedHealthcare leaders talk provider tensions, prior auth cuts
‘We want to be known as your best partner’: UnitedHealthcare leaders talk provider tensions, prior auth cuts  Becker's Hospital Review