Groups representing insurers praised CMS’s final rule for Medicare Advantage in 2026.
In a statement published April 4, Better Medicare Alliance President Mary Beth Donahue called the rule the “right decision to protect seniors and the Medicare Advantage program.”
“As we continue to review the final rule, we are encouraged that the Administration took a measured approach and declined to make major changes at this time,” Ms. Donahue said.
The Better Medicare Alliance is backed by major insurers.
In a proposed rule published in November, the Biden administration proposed major changes to the program, including requiring MA plans to cover weight loss drugs and adding regulatory guardrails around the use of AI in prior authorization.
In the final rule, the Trump administration declined to require MA plans to cover GLP-1 drugs for weight loss, a move projected to increase federal spending by $35 billion over 10 years. The decision could be revisited in future rulemaking.
In an April 4 statement, the Alliance of Community Health Plans applauded the decision to decline required coverage for GLP-1 and other weight loss drugs.
“While these drugs offer hope for many, the excessive costs carry enormous consequences for consumers, taxpayers and employers,” President and CEO Ceci Connolly said. “ACHP was the leading national payer organization to speak out against the proposed expansion, which would have been irresponsible without further long-term efficacy and safety studies and economic analysis.”
ACHP represents provider-sponsored health plans.
The administration also declined to finalize rules tightening oversight of the use of AI in prior authorization decisions. CMS said it will consider regulatory approaches to AI in the future.
