CMS has proposed extending its prior authorization interoperability framework to cover drugs for the first time, building on its 2024 rule that focused on medical items and services. The proposed rule ...

A 2024 CMS rule now requires payers, including Medicare Advantage plans, Medicaid, CHIP and ACA exchange carriers, to publicly report prior authorization metrics for the first time. The public ...

The Centers for Medicare & Medicaid Services April 10 released a proposed rule that would establish electronic standards for ...

Forty-eight insurers, including major players, pledged to reform prior authorization processes to improve patient care access. The initiative includes technology standardization, reducing PA ...

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. Health insurer prior authorization has increased considerably in ...

Medicare Advantage plans have increased their use of prior authorization and appear to be targeting certain types of care -- such as expensive post-acute hospital care -- for coverage denials, ...

Does Medicare require prior authorization? Medicare Advantage plans often require prior authorization. But these coverage reviews are rare for original Medicare. That distinction changes in 2026. Many ...

To combat growing criticism of prior authorization delays by payers, Centers for Medicare & Medicaid Services finalized a rule Wednesday that requires health plans to send prior authorization ...

For the first time, more Medicare enrollees received their Medicare benefits through a Medicare Advantage (MA) plan last year than through Traditional Medicare. We saw first-hand at the Center for ...

Digital and privacy rights nonprofit Electronic Frontier Foundation is suing the Centers for Medicare & Medicaid Services ...