New Jersey has finalized rules requiring state-regulated insurers to cap out-of-pocket costs on insulin, asthma inhalers and epinephrine auto-injectors. The state published the final regulations Dec. 1, implementing legislation Gov. Phil Murphy signed that made New Jersey the second state…
Payer Policy Updates
CMS published its 2027 Medicare Advantage and Part D proposed rule on Nov. 25 that includes an overhaul of how star ratings are calculated, new enrollment flexibilities, and rollbacks of Biden-era health equity requirements. The proposed rule is subject to…
Legally residing refugees and asylees will face new challenges with accessing health insurance coverage. The 2025 budget law will cut Medicaid spending by about $1 trillion over 10 years, and Medicaid data usage by Immigration and Customs Enforcement is slated…
U.S. Reps. Kathy Castor, D-Fla., Brian Fitzpatrick, R-Pa., and Debbie Wasserman Schultz, D-Fla., have reintroduced a bill to widen access to lung cancer screenings, according to a Nov. 20 news release. The bill prevents Medicaid, traditional Medicare, Medicare Advantage, and…
Thirteen Democrats in the U.S. House of Representatives introduced eight bills aimed at reforming Medicare Advantage and solidifying traditional Medicare, according to a Nov. 19 news release from Rep. Mark Pocan, D-Wis. Each piece of legislation falls into one of…
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The Wasteful and Inappropriate Service Reduction initiative from CMS will take effect next year, adding prior authorization requirements to traditional Medicare. Providers in Arizona, Washington, New Jersey, Texas, Ohio and Oklahoma will pilot the new protocol. Here are eight things…
Mark Cuban, the billionaire entrepreneur behind Cost Plus Drugs, criticized Sen. Bernie Sanders’ Medicare for All Act Nov. 9 on X. The bill, which would establish a nationwide health insurance program, has been a longtime agenda item for Mr. Sanders,…
Six Democratic House representatives introduced legislation this month to stop the upcoming Medicare prior authorization pilot, the Wasteful and Inappropriate Service Reduction model. WISeR would implement prior authorization for some services under traditional Medicare across six states starting next year.…
CMS is set to launch a pricing model in January that could reshape Medicaid drug costs by aligning them with rates seen in other high-income countries. Eight things to know: 1. The program allows participating drug manufacturers to offer Medicaid…
Blue Cross Blue Shield of Massachusetts is expanding its claims review process to address what it is describing as potential overcoding among physicians who routinely bill for high-complexity visits. The new policy takes effect for dates of service on or…