Payer Policy Updates

HHS Secretary Xavier Becerra is urging states to do more to prevent people from losing Medicaid coverage for procedural reasons. 

North Carolina Gov. Roy Cooper signed a bill allowing Blue Cross Blue Shield of North Carolina to reorganize as a nonprofit holding company.

HHS has added 25 drugs to its list of products eligible for Inflation Reduction Act rebates. 

The FDA and CMS are discussing how to handle obesity drugs in Medicare, Bloomberg Law reported June 7. 

Medicare will cover drugs to treat Alzheimer's disease if they receive full FDA approval, the agency said June 1. 

UnitedHealthcare is not implementing a gastroenterology endoscopy prior authorization policy set to take effect June 1 and instead will set up an advance notification process for non-screening GI procedures.  

North Carolina legislators approved a bill that would allow Blue Cross Blue Shield of North Carolina to reorganize, adding a new nonprofit parent company. 

With Medicaid redeterminations underway nationwide, CMS is urging states to ensure they do not terminate coverage for eligible individuals.

Illinois lawmakers have passed legislation to create a state-run health insurance exchange. 

CMS has finalized or proposed several policy changes in 2023, including stricter audits of Medicare Advantage plans, changes to prior authorization and regulations aimed at drug prices.