Dana Kelso Spradling says she's dealing with an insurance nightmare, after the medication she had already received a prior ...

California is one of 31 states that passed laws in 2025 limiting insurance companies’ use of prior authorization to approve ...

New Medicaid prior-authorization rules have advocates in Connecticut concerned about patients losing access to their prescription drugs.

A new federal pilot program is changing how some seniors access healthcare under traditional Medicare. As of January 1, 2026, ...

Scott Rosingnol with eHealth Exchange and others will address what providers and payers need to know at HIMSS26.

Prior authorization (PA) is a widely used insurance mechanism intended to ensure cost-effective, evidence-based care. However, in practice, it often imposes significant administrative and clinical ...

GVSU is financing a bond of up to $139 million, a decision applauded by university leaders and decried by some faculty ...

Massachusetts insurance regulators unveiled sweeping prior authorization reforms that would scrap pre-approval requirements for "many routine and essential" health care services, Gov. Maura Healey ...

A six-state pilot program will target 'wasteful care' under Medicare Medicare programs in six states will face prior authorizations under a new pilot program. Traditional Medicare in six states will ...

Medicare is launching a new pilot program that will require prior approval for 17 health services using artificial intelligence tools. The Wasteful and Inappropriate Service Reduction (WISeR) model is ...

Prior authorization has long been a sticking point between payers and providers, with payers arguing that it’s necessary to control costs and ensure that care is medically necessary and providers ...

Medicare enrollees in Texas will soon be required to get prior authorization for certain medical services – and artificial intelligence will play a central role in those decisions. Beginning Jan. 1, a ...