Becker's Healthcare November 27, 2024
On Nov. 26, CMS proposed reforms to the Medicare Advantage and Part D programs for contract year 2026, including changes to prior authorization and GLP-1 coverage.
Here are 10 things ASC leaders and physicians need to know about the proposed reforms:
1. The agency is seeking feedback on how MA medical loss ratios are calculated in order to address concerns surrounding vertical integration across the industry.
2. Part D plans and Medicaid programs may provide coverage of GLP-1s for obesity after previously being excluded.
3. CMS is looking to “address concerns about the overuse of prior authorization” by clarifying definitions for internal coverage criteria, creating stricter transparency requirements for payers, ensuring enrollees are informed about their rights to...
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