Payer Policy Updates

Aetna considers Aduhelm to be medically necessary and said Sept. 13 it will cover the controversial Alzheimer's drug if certain criteria are met. 

Updated COVID-19 boosters designed to target the omicron variant will be provided at no cost, regardless of insurance status, CMS said Sept. 12. 

CMS approved extending Medicaid and Children's Health Insurance Program coverage for a full year after pregnancy for women in Indiana and West Virginia. 

A federal judge in Texas awarded a partial victory Sept. 7 to opponents of the ACA who challenged a key provision that requires payers and employers to cover preventive services.

The Biden-Harris Administration proposed a new CMS rule Aug. 31 to overhaul the enrollment processes for Medicaid, the Children’s Health Insurance Program, and Basic Health Programs.

Senate Finance Committee Chairman Ron Wyden has launched a probe into potentially deceptive marketing tactics used by Medicare Advantage plans. 

Payers with large Medicaid operations are expected to face negative pressure on revenues if the federal public health emergency ends in October, but the total impact on profits is likely to be small because of coverage alternatives offered by the…

Massachusetts Gov. Charlie Baker signed legislation Aug. 10 that overhauls the state's mental/behavioral healthcare delivery system and reforms prior authorization practices within the specialty. 

HHS, the Labor Department and Treasury Department put payers on notice that they are required to cover birth control and family planning counseling under the Affordable Care Act in every state.

Senate Democrats reached a deal June 27 on a major healthcare and energy reform bill that will extend Affordable Care Act tax credits to 2025, empower Medicare to negotiate the cost of some drugs and put the U.S. on a…