A series of class actions over the exclusion of coverage for GLP-1 weight loss drugs is testing several legal strategies ...

Please provide your email address to receive an email when new articles are posted on . On April 4, CMS announced it would not include Medicare Part D coverage of obesity drugs in its rule changes for ...

Chandra is an emergency physician and global health policy specialist. Hoover is a former federal worker, sociobehavioral researcher, and global health technical specialist. We both lost our jobs as ...

Although the literature has investigated utilization management practices, how they align with clinical practice guidelines is not well understood. 10, 11 A better understanding of this alignment ...

The Centers for Medicare and Medicaid Services on Friday issued a 2026 Medicare Advantage and Part D final rule that makes changes to authorization decisions. One provision restricts a plan's ability ...

Starting in January, Medicare will test out an artificial intelligence (AI) pilot program to decide whether patients get certain procedures covered or not. The Centers for Medicare & Medicaid Services ...

Experts discuss the cost of lipoprotein(a) (Lp[a]) tests and how these costs, along with the National Lipid Association’s (NLA) recommendation and supporting clinical evidence, may influence payer ...