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…
Payer Policy Updates
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…
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Elevance Health has shared plans to potentially penalize hospitals and other contracted facilities that use care providers who are not in-network with its Anthem Blue Cross Blue Shield commercial plans in 11 states. Under the policy, finalized Oct. 1 and…
California Gov. Gavin Newsom vetoed a state bill that would have required health insurance policies with outpatient prescription drug benefits to cover up to a year of hormone therapy, according to an Oct. 13 update to the legislation. Current law…
Michigan Gov. Gretchen Whitmer signed legislation Oct. 7 that aims to preserve the state’s Medicaid funding by maintaining its Insurance Provider Assessment tax. The new law instructs the state to request a waiver from CMS to continue the tax on…
California Gov. Gavin Newsom signed a law that aims to curb inflated drug pricing by pharmacy benefit managers on Oct. 11. The legislation restricts “spread pricing,” wherein PBMs charge a plan or insurer more than the total paid to the…
Republican lawmakers are reviving proposals that failed to make it into the sweeping One Big Beautiful Bill Act, turning their focus to a trio of measures that could reshape how employers offer health benefits through Individual Coverage Health Reimbursement Arrangements,…