CMS is proposing a five-year experiment that would allow state Medicaid programs and Medicare Part D plans to cover GLP-1s for weight management on a voluntary basis, according to an Aug. 1 report from The Washington Post. Ozempic, Wegovy, Mounjaro and Zepbound would be included in the program, along with Eli Lilly’s oral GLP-1, Orforglipron, if it’s approved next year.
The U.S. Department of Health & Human Services has finalized a series of new rules related to the use of technology for electronic prescribing and prior authorization. In the rules, the Assistant Secretary for Technology Policy and the Office of the National Coordinator for Health IT have added requirements for real-time prescription benefit checks at the point of care and formally adopted FHIR certification for prior auth.
A recent survey has shown that virtual nursing has yet to be fully embraced in acute inpatient care, but holds much promise, 74% of hospital leaders believe that virtual nursing will become an integral part of the care delivery models. That is up from 66% last year, although only 10% of hospital leaders and 14% of IT leaders have integrated virtual nursing into their standard care models. The survey was conducted in partnership with the American Organization for Nursing Leadership and reached over 1,000 healthcare professionals working in acute care settings.
Major payers faced another mixed quarter financially amid ongoing cost pressures in Medicare Advantage (MA) and new challenges emerging on the Affordable Care Act's (ACA's) exchanges.
While Wall Street may be souring on industry bellwether UnitedHealth Group, the company still led the pack on profits in the second quarter with $3.4 billion. The next-highest earner was Elevance Health, at $1.7 billion in profit, followed by the Cigna Group with $1.5 billion.
CMS has released three final payment rules with various updates for inpatient rehabilitation facilities, hospices and inpatient psychiatric facilities for fiscal year 2026. A summary of 15 key things to know is included below and the 86-page final rule is available here.
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