News Briefs: CMS Finalizes New Prior Authorization Requirements

The Biden administration on Jan. 17 finalized its interoperability and prior authorization (PA) requirements for government-funded payers, including insurers offering Medicare Advantage and managed Medicaid plans as well as plans on federally facilitated exchanges. CMS said in a press release that “these policies will improve [PA] processes and reduce burden on patients, providers, and payers” and estimated they would lead to $15 billion of savings over a 10-year period. The rules include a requirement that MA and Medicaid plans starting in 2026 will have to send PA decisions within 72 hours for urgent requests and seven days for non-urgent requests. Payers will also have to disclose a reason for denying a PA request and publicly report PA metrics.

The Cigna Group has named Brian Evanko president and CEO of Cigna Healthcare, its health insurance arm. Evanko will continue to serve as The Cigna Group’s chief financial officer, a role he has held since January 2021. He previously led Cigna Healthcare’s U.S. government business. Cigna also promoted Bryan Holgerson to president of Cigna Healthcare’s U.S. commercial business, replacing Mike Triplett, who will retire by the end of the year. In addition, The Cigna Group hired Ann Dennison as deputy CFO. Dennison was previously the CFO at Nasdaq. Further, Evernorth President and CEO Eric Palmer expanded his role to lead The Cigna Group’s enterprise strategy and corporate development teams.

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AIS Health Staff

AIS Health Staff

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