Reimbursement Changes

FDA Clears Daraxonrasib Expanded Access for Pretreated Metastatic Pancreatic Cancer

George Padron
Oncology Care, Healthcare Headlines, Policy & Legislation, Reimbursement Changes | May 1, 2026
FDA approved expanded access to the RAS inhibitor daraxonrasib for patients with previously treated metastatic pancreatic cancer just two days after Revolution Medicines requested it.

Insurer Claims of Prior Authorization Cutbacks Draw Skepticism From Physicians and Policy Experts

George Padron
Prior Authorization & Appeals, Medicare/Medicaid Updates, Coverage Navigation Strategies, Appeals & Denials Management, Reimbursement Changes, Practice Management, Regulatory & Legislative Updates | Apr 13, 2026
AHIP says insurers eliminated 6.5M prior authorizations for medical services, but critics call the announcement vague and say prescription drugs were excluded.

Medicare's AI-Driven Prior Authorization Pilot Draws Physician Backlash and a Federal Lawsuit

Sonia Reyes
Prior Authorization & Appeals, State & Federal Regulations, Medicare/Medicaid Updates, Healthcare Headlines, Policy & Legislation, Reimbursement Changes, Practice Management, Regulatory & Legislative Updates | Apr 10, 2026
Three months into Medicare's WISeR prior auth pilot, physicians report widespread claim denials, and the EFF has sued CMS for transparency on AI vendor practices.

CMS Delivers a Rate Reprieve for Medicare Advantage Plans in 2027

George Padron
Medicare/Medicaid Updates, Healthcare Headlines, Reimbursement Changes | Apr 8, 2026
CMS finalized a 2.48% Medicare Advantage payment increase for 2027, adding $13B in insurer payments and reversing a January proposal that rattled markets.

AMA Updates Maternity Code as Billing Catches Up To Birth

George Padron
Reimbursement Changes, Care Coordination | Mar 3, 2026
Starting January 2027, the AMA's new itemized maternity CPT codes will give managed care plans earlier visibility into member pregnancies, supporting better care coordination and outcomes.