Becker's Healthcare November 26, 2024
CMS proposed major reforms on Nov. 26 for the Medicare Advantage and Part D programs for contract year 2026, including changes to prior authorization and weight loss drug coverage.
The agency is also looking for feedback on how MA medical loss ratios are calculated in order to address concerns surrounding vertical integration across the industry.
10 key proposals:
1. Weight loss drug coverage: Part D plans and Medicaid programs could provide coverage of GLP-1s for obesity after previously being excluded (unless they were being used to treat conditions such as diabetes).
2. Tightened prior authorization rules: CMS is looking to “address concerns about the overuse of prior authorization” by introducing clearer definitions for internal coverage criteria, stricter transparency requirements...
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