Health insurance coverage for prescription medications declined with increased restrictions in 2025, impacted by pharmacy benefit manager policies and limited regulations.

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.

Explore Humana's detailed prior authorization requirements for medical services and medications, including timelines, appeal rights, and Medicare member guidance for coverage approvals.

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.

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.

Ozarks Community Hospital highlights financial challenges in rural healthcare due to lower Medicare Advantage reimbursements and the value of nonprofit status in accessing grants.

Summary of Medicare payment reductions used to fund Medicaid expansion under ACA, highlighting impact on hospital financial stability and Medicare's long-term obligations.

The Center for Medicare and Medicaid Innovation has missed cost-saving goals, increasing federal spending by billions. Policymakers consider ending CMMI amid concerns over inefficient Medicare and Medicaid reforms.

The Trump administration is advancing plans to make Medicare Advantage the default enrollment for all Medicare recipients, raising concerns about beneficiary choice and increased costs to taxpayers.

Explore the American Urological Association's 2025 advocacy priorities focused on Medicare payment reform, workforce expansion, prior authorization reforms, drug shortages, and AI integration in healthcare.