Oregon to Increase Payments to Medicaid MCOs 

November 13, 2025

medicaid

The Oregon Health Authority (OHA) announced that it will be increasing payments made to Medicaid Coordinated Care Organizations (CCOs) by an average of 10.2% in 2026. The increase is meant to help stabilize the Oregon Health Plan and support CCOs as they face increased financial strain due to higher utilization. OHA will also take targeted actions in policy to contain Medicaid costs and ensure program sustainability. Some cost containment measures already taken by OHA include requiring CCOs to refund OHA if behavioral health costs are low in 2026, reducing funding for the CCO Quality Incentive Program, and narrowing eligibility for enhanced directed behavioral health care to providers that offer team-based care, pending federal approval.

legislation

Virginia and Hawaii Introduce PDAB Legislation

The Virginia Senate introduced a bill to establish a Prescription Drug Affordability Board (PDAB) to review drugs with a wholesale acquisition cost (WAC) of $60,000 or more per year or a WAC increase of $3,000 or more in any 12-month period. For drugs deemed to cause an affordability challenge, the legislation authorizes the PDAB to […]
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February 12, 2026

EGWP marketplace medicaid Medicare

Solutions

AHIP Shares Update on Plan Progress to Simplify Prior Authorization

AHIP shared progress on the voluntary, multi-year commitments made by AHIP, BCBSA, and leading health plans (including Cigna Healthcare) to streamline and simplify prior authorization. Health plans serving nearly 270 million Americans are participating in this initiative. The 2026 commitments took effect on Jan. 1 and include: reducing the scope of claims subject to prior […]
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February 12, 2026

EGWP marketplace medicaid Medicare

legislation

DOL Issues Proposed Rule on Improving Transparency into PBM Fees

Pursuant to President Trump’s Executive Order “Lowering Drug Prices by Once Again Putting Americans First,” the Department of Labor’s (DOL’s) Employee Benefits Security Administration (EBSA) issued a proposed rule that would require providers of PBM services and affiliated entities of brokerage and consulting services to disclose direct and indirect compensation to their self-funded ERISA fiduciary […]
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February 12, 2026

EGWP marketplace medicaid Medicare

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