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Medicare Final Rule 2026 | AI, Weight Loss Drugs & Prior Authorizations Under Scrutiny
It’s time for Episode 3 of Compliance Deconstructed and today, Jessica Zeff, Lorie Davis, and Elvan Baker break down the recent Medicare final rule updates effective January 1, 2026, focusing on what was left out, positive changes, and how compliance professionals can navigate the evolving regulatory environment.
A key focus of discussion are the absence of clear AI guidelines, coverage decisions on anti-obesity medications, and prior authorization requirements continue to create challenges for healthcare organizations.
The conversation also highlights some encouraging developments, including the elimination of cost sharing for adult vaccines, caps on insulin costs, and expanded access to behavioral health providers within Medicare Advantage plans. These changes aim to improve patient access and promote preventive care.
Jessica, Lorie, and Elvan also cover practical strategies for compliance teams to manage these ongoing shifts, emphasizing the importance of education, clear communication, and cross-departmental collaboration. Proactive engagement helps organizations implement new rules smoothly while maintaining compliance.
To conclude, your hosts underscore the value of networking within the compliance community to share insights and tackle uncertainties together. As you’ll learn, staying informed and connected is key to successfully adapting in this dynamic Medicare landscape.
Key Takeaways:
- Clear guidelines on AI usage in Medicare remain unresolved, creating ongoing compliance risks.
- Anti-obesity medications are still excluded from Part D coverage, raising questions about equitable patient access.
- Prior authorization requirements remain unclear, adding complexity to administrative processes.
- Elimination of cost sharing for adult vaccines enhances access to preventive care.
- Capping insulin costs aims to improve medication adherence for beneficiaries with diabetes.
- Expanded Medicare Advantage coverage now includes more behavioral health providers, improving mental health access.
Learn more about Healthcare Compliance and discover how Simply Compliance can help your company at simplycomplianceconsulting.com.
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By Jessica Zeff, Lorie Davis, & Elvan BakerIt’s time for Episode 3 of Compliance Deconstructed and today, Jessica Zeff, Lorie Davis, and Elvan Baker break down the recent Medicare final rule updates effective January 1, 2026, focusing on what was left out, positive changes, and how compliance professionals can navigate the evolving regulatory environment.
A key focus of discussion are the absence of clear AI guidelines, coverage decisions on anti-obesity medications, and prior authorization requirements continue to create challenges for healthcare organizations.
The conversation also highlights some encouraging developments, including the elimination of cost sharing for adult vaccines, caps on insulin costs, and expanded access to behavioral health providers within Medicare Advantage plans. These changes aim to improve patient access and promote preventive care.
Jessica, Lorie, and Elvan also cover practical strategies for compliance teams to manage these ongoing shifts, emphasizing the importance of education, clear communication, and cross-departmental collaboration. Proactive engagement helps organizations implement new rules smoothly while maintaining compliance.
To conclude, your hosts underscore the value of networking within the compliance community to share insights and tackle uncertainties together. As you’ll learn, staying informed and connected is key to successfully adapting in this dynamic Medicare landscape.
Key Takeaways:
- Clear guidelines on AI usage in Medicare remain unresolved, creating ongoing compliance risks.
- Anti-obesity medications are still excluded from Part D coverage, raising questions about equitable patient access.
- Prior authorization requirements remain unclear, adding complexity to administrative processes.
- Elimination of cost sharing for adult vaccines enhances access to preventive care.
- Capping insulin costs aims to improve medication adherence for beneficiaries with diabetes.
- Expanded Medicare Advantage coverage now includes more behavioral health providers, improving mental health access.
Learn more about Healthcare Compliance and discover how Simply Compliance can help your company at simplycomplianceconsulting.com.