December 15, 2022
  • CMS released a proposed rule to improve prior authorization processes for Medicare Advantage (MA) and implement the Inflation Reduction Act’s drug price provisions. The rule clarifies when and how MA plans can use prior authorization and that once approved, the prior authorization shall remain valid for the beneficiary’s full course of treatment. The agency is including new flexibilities for Part D plans to offer biological products and authorized generics on their formularies. The rule would also include a health equity index for the 2027 star ratings for MA and Part D plans. (Article here)