Medicare Is of Two Minds on Prior Authorization

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Source: MedPage Today

Original: https://www.medpagetoday.com/practicemanagement/reimbursement/119157...

Published: Fri, 26 Dec 2025 10:00:00 -0500

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced an agreement with Medicare Advantage plans to reduce the use of prior authorization. The agency also said it would conduct a demonstration. Medicare is of two minds on the prior authorization issue.1 These changes are part of broader adjustments for 2025, including CMS' 1,327-page final rule affecting agent and broker compensation. Compensation for initial enrollment in Medicare Advantage and Part D plans will increase by $100. Experts predict that insurers may respond by increasing prior authorization for drugs, limiting drug coverage, and increasing premiums and deductibles in Part D.[1] In 2025, a cap on out-of-pocket drug spending is imposed at $2,000.[3][8]