Policy Updates

UnitedHealth Group's OptumRx will keep Humira in its drug formulary, in addition to three biosimilar competitors, Bloomberg reported Nov. 15. 

U.S. Senate Democrats are urging CMS to continue its oversight of Medicare Advantage marketing practices and introduce additional regulations to protect consumers from deceptive tactics.

Newly capped insulin prices for Medicare beneficiaries at $35 won't show up in Medicare Plan Finder this year. 

The U.S. will extend the COVID-19 public health emergency past January 11, 2023, CNBC reported Nov. 11.

Four states are moving toward policies to keep children continuously enrolled in Medicaid to prevent coverage gaps, Kaiser Health News reported Nov. 10. 

CMS wants all traditional Medicare beneficiaries and most Medicaid beneficiaries in accountable care organizations by 2030. In a strategy report published Nov. 7, CMS detailed its plans to reach this goal. 

A CMS rule finalized Oct. 28 will reduce gaps in Medicare enrollment for new enrollees and adds special enrollment periods for extenuating circumstances. 

CMS is cracking down on deceptive marketing practices and will no longer allow Medicare Advantage or Part D prescription drug plans to advertise on television without agency approval first.

The Transparency in Coverage (TiC) final rule went into effect July 1, 2022, and requires insurers to include provider-negotiated rates, as well as allowed billable amounts for all out-of-network providers. 

The nation's uninsured rate is at a record low thanks in part to continuous Medicaid enrollment since early 2020. But with the federal public health emergency expected to come to a close in 2023, payers are prepping for a major…