On January 27, 2025, Aimed Alliance submitted a comment on the Centers for Medicare & Medicaid Services (CMS) proposed rule changes for the 2026 Medicare and Medicaid plan year. Aimed Alliance urged CMS to monitor access to Inflation Reduction Act (IRA)-negotiated prescription drugs and increase transparency in AI-driven coverage determinations.
The IRA of 2022 enables Medicare to negotiate drug prices, but its implementation could lead to restrictive formularies, increased prior authorization, and delays in treatment access. To prevent such consequences, Aimed Alliance recommended that CMS implement an oversight system to track formulary changes, prescription utilization, and out-of-pocket costs, as well as ensure a clear reporting mechanism to flag access issues.
Furthermore, recent lawsuits allege that Medicare Advantage plans have used AI to deny claims improperly. However, many beneficiaries are unaware of AI’s role in coverage decisions, limiting their ability to challenge unfair denials. Thus, Aimed Alliance urged CMS to require health plans to disclose when AI is used in coverage determinations, ensuring transparency and enabling beneficiaries to challenge improper denials. Read the letter here.
Last Updated on February 1, 2025 by Aimed Alliance