Your Academy submitted comments to Centers for Medicare and Medicaid Services (CMS) regarding the proposed Contract Year (CY) 2026 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs. The Academy’s comments focused on thanking CMS for its recent efforts to limit excessive prior authorization requirements from MA plans and expressing support for ongoing work on this issue.

This proposed rule was issued on November 26, 2024, and would update regulations governing Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicaid, Medicare cost plans, and Programs of All-Inclusive Care for the Elderly (PACE). This proposal would address topics such as Star Ratings, marketing and communications, agent/broker compensation, health equity, drug coverage, dual eligible special needs plans (D-SNPs), utilization management, network adequacy, and other program areas, including the Medicare Drug Price Negotiation Program, as well as codify existing sub regulatory guidance in the Part C and Part D programs.

The Academy also joined coalition comments from the Regulatory Relief Coalition (RRC) and the Coalition to Preserve Rehabilitation (CPR) on this proposed rule, emphasizing the need for reforms in prior authorization and utilization management for Medicare Advantage plans, implementation of AI safeguards to ensure patient access to care, and other policy proposals.

Please contact Academy staff at healthpolicy@aapmr.org with any questions or concerns on this proposal or prior authorization reform.