The Centers for Medicare & Medicaid Services (CMS) will implement the Wasteful and Inappropriate Service Reduction (WISeR) Model beginning January 1, 2026, through December 31, 2031. This pilot applies to Original Medicare only, not Medicare Advantage, and operates in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
The U.S. Food and Drug Administration (FDA) has awarded the first-ever National Priority (NP) Vouchers to nine sponsors as part of its new Commissioner’s National Priority Voucher (CNPV) Pilot Program. These vouchers provide priority review for future submissions, supporting the rapid advancement of treatments in areas of public health importance such as antimicrobial resistance, rare diseases, and domestic manufacturing resilience.
A clear timeline of U.S. healthcare price transparency, from early state actions and ACA mandates to today’s CMS rules and enforcement.
White House reaches first Most-Favored-Nation pricing deal, realigning U.S. drug costs to international benchmarks and reshaping payer and provider reimbursement strategies.
CMS finalizes 2028 Medicare Drug Price Negotiation guidance, expanding orphan drug protections, integrating Medicare Advantage data, and clarifying vaccine treatment.
URAC has unveiled the country’s inaugural Health Care AI Accreditation program, an independent framework that evaluates artificial-intelligence solutions for safety, equity, transparency, and measurable clinical impact. The new credential offers payers and providers a concrete way to vet AI tools, align with emerging regulatory guidance, and advance value-based care objectives while mitigating compliance and reputational risk.
CMS has released new guidance tightening federal oversight of Medicaid state-directed payments (SDPs) in managed care. The update centers on transparency, documentation, and measurable quality outcomes—signaling stronger guardrails on financing, distribution methodologies, and alignment with actuarial soundness and value-based care. Payers, providers, and state agencies should prepare for enhanced monitoring and reporting expectations.
HHS has finalized a rule (HTI-4) to deliver real-time prescription drug price transparency at the point of care, giving clinicians and consumers visibility into patient-specific coverage, out-of-pocket costs, and prior authorization requirements through certified health IT. The move aims to reduce administrative burden, speed access to therapy, and support more cost-effective prescribing aligned with value-based care goals.
HHS and CMS are creating the Healthcare Advisory Committee, a group of experts tasked with providing strategic recommendations directly to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz.
The goal: improve how care is financed and delivered across Medicare, Medicaid, CHIP, and the Health Insurance Marketplace, while reducing red tape and putting patients first.
The Centers for Medicare & Medicaid Services’ (CMS) WISeR model (originally designed to streamline utilization management and prior authorization processes) is facing renewed attention from lawmakers. A bipartisan congressional letter sent to CMS questions the agency’s legal authority to apply the model to traditional Medicare and warns of potential impacts on beneficiary access, provider operations, and program compliance. As the healthcare industry awaits CMS’ response, payer and provider organizations should prepare for possible policy adjustments that could affect authorization workflows, clinical operations, and financial performance.
