California Gov. Gavin Newsom signed a law that aims to curb inflated drug pricing by pharmacy benefit managers on Oct. 11. The legislation restricts “spread pricing,” wherein PBMs charge a plan or insurer more than the total paid to the…
Policy Updates
Republican lawmakers are reviving proposals that failed to make it into the sweeping One Big Beautiful Bill Act, turning their focus to a trio of measures that could reshape how employers offer health benefits through Individual Coverage Health Reimbursement Arrangements,…
Pennsylvania lawmakers introduced a bill in October to regulate AI use in health insurance, joining a wave of states attempting to add guardrails in the payer space, especially after an early draft of the One Big Beautiful Bill Act included…
Despite Cigna launching its downcoding policy on Oct. 1, the insurer is temporarily holding off on implementing it for California HMO plans, according to the California Medical Association and Cigna. The policy allows Cigna to adjust some higher-level evaluation and…
The American Hospital Association is encouraging HHS Secretary Robert F. Kennedy Jr., CMS Administrator Mehmet Oz, MD, and insurers to follow through on prior authorization reforms. In a letter to the CMS and HHS leaders, the AHA emphasized that 95%…
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Average premiums, benefits and plan choices for Medicare Advantage and the Medicare Part D prescription drug program should remain relatively stable next year, CMS said in a Sept. 26 news release. But MA enrollment is projected to decrease 900,000 in…
Federal lawmakers have introduced a handful of bills aimed at speeding up prior authorization and cracking down on upcoding in Medicare Advantage. Not all of the introduced bills have been heard in committee. Here are eight proposals introduced in 2025…
CMS has finalized a rule requiring Medicare Advantage plans to submit provider directory data for inclusion in the Medicare Plan Finder. The change, aimed at improving transparency and beneficiary decision-making, takes effect January 1, 2026. Under the rule, MA plans…
The Congressional Budget Office found permanently expanding ACA enhanced premium tax credits prior to the federal government’s Sept. 30 fiscal year end would boost the insured population by 3.8 million people over the next decade, while increasing the deficit by…
A group of Republican lawmakers is pressing the Trump administration to step up enforcement of the No Surprises Act, citing ongoing problems with implementation and the IDR process. “We request the departments finalize clear and consistent QPA calculation methodology, accelerate…