Health insurance stories

Oct 16, 2026

CMS proposes rule to improve Medicare Advantage provider directories and PBM transparency

The Centers for Medicare & Medicaid Services issued a proposed rule requiring Medicare Advantage plans to maintain accurate provider directories and implementing new transparency requirements for pharmacy benefit managers. The changes would implement key healthcare provisions from a government funding package.

Oct 16, 20263 sources

Sep 1, 2026

UnitedHealthcare removes prior authorization requirement for 1,700 procedure codes

UnitedHealthcare announced it is eliminating prior authorization requirements for 1,700 diagnostic and procedure codes starting in October 2026, part of its commitment to reduce utilization management controls by 30%. The move received cautious approval from healthcare experts, though some questioned the practical impact of the changes.

Sep 1, 20263 sources

Top claims

▪Jesse Dresser cautioned that emerging cost-plus contracting models designed for retail pharmacies may lack adequate dispensing fees for specialty pharmacy work.
▪A 2018 Centers for Medicare & Medicaid Services review found Medicare Advantage provider directory inaccuracy rates ranged from 5% to 93% across examined health plans.
▪In fall 2025, the Centers for Medicare & Medicaid Services finalized a rule requiring Medicare Advantage plans to update provider directories within 30 days of changes.

Subtopics

Drug Policy, Pricing & Approval1 Federal agencies1 Healthcare Access and Insurance1 Healthcare Policy1 Medicare1 Medication Pricing & Affordability1 Pharmacy benefit managers1 Public healthcare1 Regulatory reform1 U.S. healthcare policy1

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