Briana Contreras

Medicare Advantage 2027 updates boost payment updates near 5%, but risk rules and prior auth reforms force plans to rethink benefits and strategy.

A pharmacist-led specialty pharmacy model that expands into care management services could help health systems improve chronic disease outcomes while supporting cost savings under value-based care, according to presenters at the Asembia Specialty Pharmacy Summit that took place in Las Vegas this week.

Mayo Clinic experts said managing high-cost drugs requires clear definitions, strong formulary review processes and closer collaboration among health systems, payers and manufacturers to balance access, cost and quality of care.

A randomized trial found that combining the opioid Dilaudid (hydromorphone) with the cannabinoid Marinol or Syndros (dronabinol) did not improve pain, function or safety outcomes compared with either drug alone in patients with knee osteoarthritis.

UnitedHealthcare will remove prior authorization requirements for 30% of services as part of efforts to ease administrative burden and improve access to care.

A new program from the Cleveland Clinc comes as pediatric mental health visits continue rising nationwide and health systems look to expand care options between outpatient therapy and inpatient hospitalization.

Updated FDA labeling and NCCN recommendations are pushing more health systems and payers to adopt DPYD testing before fluoropyrimidine treatment to help reduce serious toxicities in cancer care.

Prior authorization reform, AI deployment, GLP-1 management and specialty drug costs are among the issues reshaping payer and provider strategy this year.

UnitedHealthcare prior authorization changes cut approvals 30% as AHIP pushes e‑processing; Larry Levitt of KFF warns voluntary moves may not last.

Key Takeaways Intensifying prior authorization reform is yielding reported requirement reductions, but payers remain committed to utilization management rather than eliminating controls.