Medicare enrollees in Texas will soon be required to get prior authorization for certain medical services – and artificial intelligence will play a central role in those decisions. Beginning Jan. 1, a ...

Understanding the Context

Fierce Healthcare: A look at the state of prior authorization in Medicaid A new analysis from KFF and Health Management Associates takes a dive into prior authorization practices for Medicaid managed care organizations. The study polled state programs on policies in place ... Becker's Hospital Review: CMS proposes extension of prior authorization rule to cover drugs: 6 notes 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 ...

Key Insights

CMS proposes extension of prior authorization rule to cover drugs: 6 notes The Trump administration has issued a proposed rule that aims to significantly overhaul prior authorization for pharmaceuticals. | The Trump administration has issued a proposed rule that aims to ... Becker's Hospital Review: Payers’ prior authorization denial rates go public: 5 notes