Arizona Mandates Independent Medical Director Reviews for Claims Denials
Arizona mandates independent medical director reviews for health insurer claims denials and prior authorizations based on medical necessity, effective June 2026.
Trump Administration to Reintroduce 'Most Favored Nation' Drug Pricing for Medicare
The Trump administration plans to reintroduce a 'most favored nation' drug pricing model for Medicare, aiming to align U.S. drug prices with lower international rates. This strategy faces industry opposition but could complement existing Medicare drug price negotiations to reduce costs.
Smaller U.S. Insurers Gain Market Share as Major Players Face Challenges in 2025
In 2025, major U.S. health insurers face financial and operational setbacks while smaller, focused payers achieve significant growth by leveraging market-specific strategies and managing costs effectively, reshaping the Medicare Advantage and ACA markets.
Journey of Care Launches Colorado-Based Value-Focused Palliative Care Provider
Colorado's Journey of Care introduces a dedicated value-based palliative care model targeting Medicare Advantage and special needs plans with interdisciplinary services and telehealth support.
HHS OIG Identifies $17 Billion in Potential Savings in Healthcare Programs
The HHS Office of Inspector General identifies $17 billion in potential cost savings by improving program efficiency and compliance in healthcare programs.
SMART Health Care Act Targets Medicare Abuse & Hospital Overbilling
Rep. Spartz introduces the SMART Health Care Act to reduce Medicare and Medicaid waste, address hospital overbilling, enhance rural healthcare access, and reform the 340B drug program.
CMS GUIDE Model Transforms Medicare Dementia Care with Home-Based Focus
CMS's GUIDE Model is reshaping Medicare dementia care with home-based solutions, virtual nursing, and new respite care reimbursements to improve patient outcomes and reduce costs.
Humana's Prior Authorization Process for Medical Services and Medications
Explore Humana's detailed prior authorization requirements for medical services and medications, including timelines, appeal rights, and Medicare member guidance for coverage approvals.
Medicare Caps Oral Cancer Drug Costs and Expands Payment Options in 2025
New Medicare Part D rules in 2025 cap oral cancer drug costs at $2,000 annually and introduce a voluntary monthly payment plan to improve affordability for patients.
U.S. Healthcare Budget Reconciliation Delayed Amid Medicaid, Medicare, and HHS Oversight Developments
Updates on U.S. healthcare budget reconciliation delays, Medicaid policy debates, Medicare Advantage lawsuits, HHS budget for FY 2026, and new NIH research initiatives shaping insurance and healthcare regulation.