Policy Updates

Humana, UnitedHealthcare and Cigna changed or paused policies this year after receiving criticism from medical groups and other organizations. 

The first wave of UnitedHealthcare's previously announced 20 percent reduction in prior authorization requirements takes effect Sept 1. 

The American Hospital Association, American Medical Association, AHIP and the Blue Cross Blue Shield Association are urging CMS not to move forward with implementing electronic transaction standards for healthcare attachments during prior authorization they say would create "costly burdens" across…

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.