Payer Policy Updates

Lawmakers are proposing legislation that would extend incentives for value-based care in Medicare. 

Though federal price transparency requirements for payers have been in effect since July 2022, several states moved faster to enact their own requirements and add additional regulations, according to a July 21 analysis from the National Conference of State Legislatures.

The University of Texas System is planning to drop coverage for weight loss drugs such as Wegovy under its employee and retiree health plans, citing high costs and low adherence rates.

The White House is proposing stronger standards for insurers' coverage of mental health services. 

St. Louis-based Ascension has dropped coverage for weight loss drugs such as Wegovy from its employee health plan.

As insurance premiums continue to rise nationwide, lawsuits from large, self-insured employers are being filed against health insurers in an effort to access complete medical claims data and fulfill fiduciary duties under federal law.

A new bill filed in the Senate July 20 aims to lift the ban on Medicare coverage of weight loss drugs such as Ozempic and Wegovy.

CMS has approved proposals from California and Kentucky for community-based mobile intervention teams to provide behavioral crisis services to Medicaid enrollees. 

CMS is proposing broader coverage of PET scans for patients with Alzheimer's disease, which can help determine if patients are eligible for newly-approved drugs to treat the disease. 

From requiring hospitals to post the cost of services in more consumer-friendly formats to proposing complete coverage of HIV prevention drugs for Medicare enrollees, these are eight CMS updates Becker's has reported since June 22: