CMS Finalizes 2026 Medicare Advantage and Part D Rule

CMS has released its final rule for Medicare Advantage and Part D for 2026, focusing on enhancing care coordination and beneficiary protections. Key changes include streamlining prior authorization processes and clarifying supplemental benefits. However, the rule does not expand coverage for GLP-1 medications due to projected spending increases and payer opposition.

Additionally, CMS has chosen not to regulate artificial intelligence in prior authorization decisions at this time, although it remains a topic for future consideration. New provisions ensure that Medicare Advantage plans cannot retroactively deny inpatient admissions, and there is a strengthened appeals process for prior authorizations that now includes treatment course decisions.

Finally, provisions from the Inflation Reduction Act, such as Medicare drug price negotiations and caps on insulin costs, have been put into effect, continuing policies established in previous years. These changes are aimed at improving overall care and financial protection for beneficiaries, although some critical issues remain unaddressed.