Advocacy & Practice Updates — Advocacy & Practice
ASRS, Alliance Support MA Prior Authorization Reforms, Urge CMS to Take Further Action in Comments on Proposed Rule
This week, ASRS and the Alliance of Specialty Medicine submitted comments on the 2026 Medicare Advantage and Part D proposed rule. In the rule, CMS proposes further strengthening recently implemented regulations requiring Medicare Advantage (MA) plans to base coverage criteria on widely accepted clinical data by clarifying that coverage criteria includes any resource or system that interprets Medicare guidance and is used to make coverage decisions. In addition, CMS proposes to require plans make all the resources used in coverage criteria be publicly available. ASRS and the Alliance strongly supported these proposals in our comments, but continued to press the agency to address our long-standing concerns with MA plans’ utilization management practices, including our opposition to step therapy, the recommendation that the use of prior authorization be curbed significantly, and that electronic prior authorization exchange standards be extended to all drugs—both Part B and D.
(Published 1.28.25)