Policy Updates

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. 

Minnesota Gov. Tim Walz signed legislation requiring insurers to cover preventive services after a Texas judge struck down some requirements for payers to cover preventive care at no cost to members under the ACA.  

CMS is proposing a new rule for drug manufacturers, pharmaceutical benefit managers and managed care plans to increase drug price transparency in Medicaid. 

The Cigna Group is again delaying implementation of a policy that would have required the submission of medical records when using modifier 25 for all evaluation and management claims billed with CPT codes 99212-99215 and a minor procedure.