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 ...

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 ...

Some Medicare recipients are set to experience a new “prior authorization” measure as the Centers for Medicare & Medicaid Services (CMS) trials its much-discussed “Wasteful and Inappropriate Service ...

For decades, Americans have endured a healthcare system where access to care is delayed not by clinical need, but by administrative demands with little benefit. Prior authorization, the process ...

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

Forbes contributors publish independent expert analyses and insights. Diane Omdahl is a Medicare expert who keeps her readers in the know. On June 27, 2025, the Centers for Medicare and Medicaid ...

US health insurers are advancing toward real-time prior authorization decisions by 2027 after reducing request volumes by 11%, eliminating 6.5 million transactions in 10 months. Insurers are working ...

But making sense of the numbers isn't easy, experts say ...

Major health insurance providers have agreed to reduce the need for prior authorization — the requirement that patients must get approval from insurers before receiving certain treatments or risk ...

Major insurers have cut 11% of prior authorizations after committing to roll back the controversial processes last year, according to major trade groups. The reduction equates to 6.5 million fewer ...

The fifth annual Abarca Forward conference, hosted by the pharmacy benefit manager (PBM) Abarca Health at its headquarters in ...

Between one-off charges, administrative fees, and office visit copays, some are trying ...