December 10, 2024
On Nov. 26, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year (CY) 2026 Medicare Advantage (MA) and Part D Policy and Technical Changes proposed rule, which proposes numerous changes and updates to MA and Part D policies for the 2026 contract year.
CMS includes proposals addressing prior authorization, utilization management, and artificial intelligence guardrails; the Medicare Prescription Payment Plan; Part D network pharmacy requirements; formulary inclusion and placement of generics and biosimilars; Star Ratings; provider directories; and changes to medical loss ratio reporting, among other topics.
Notably, CMS also proposes to expand coverage of anti-obesity medications (AOMs) in both Medicare and Medicaid by reinterpreting the statute to permit coverage of AOMs for the treatment of obesity when such drugs are indicated to reduce excess body weight and maintain weight reduction long-term for individuals with obesity. Cigna will work with impacted business areas to develop comments by the Jan. 27 deadline.
You may also like
