Payer & Managed Care Strategies

Synthesis:

In the past 24 hours, CMS under the Trump administration has proposed the 2026 CMS Interoperability Standards and Prior Authorization for Drugs Rule, requiring payers—including MA plans and Medicaid managed care—to implement electronic prior authorization and meet shorter turnaround times for pharmacy benefit decisions, directly targeting longstanding frictions in value-based arrangements and care coordination. This move addresses loopholes left by the 2024 rule and raises the bar for payer administrative responsiveness, with immediate implications for managed care organizations and ACOs seeking to optimize risk contracts and patient outcomes amid regulatory push for greater transparency and tech-enabled workflows (CMS proposes new deadlines for prior authorizations for drugs, Health Tech Nerds summary).