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Articles by From the College

ACR Urges Strong AI Safeguards in State Model Legislation

Joseph Cantrell, JD  |  

In comments to the National Association of Insurance Commissioners, the ACR outlined several recommendations for a proposed state model law addressing the use of artificial intelligence in the insurance industry.

CMS to Implement AI-Based Model to Streamline Prior Authorization

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Last week, the Centers for Medicare & Medicaid Services (CMS) announced that it is implementing a new prior authorization model called the Wasteful and Inappropriate Services Reduction (WISeR) Model. This six-year model, starting on Jan. 1, 2026, aims to reduce fraud, waste and abuse in traditional Medicare by using technology-enabled processes for prior authorization and…

Aetna Implements Specialty Pharmacy Requirements

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On July 1, Aetna launched its new Combined Benefit Management Drug List, effectively moving romosozumab-aqqg (Evenity) and infliximab (Remicade) to pharmacy-only coverage for most fully insured commercial plans. The ACR has contacted Aetna leaders to raise concerns about patient access to these therapies.

Executive Order Ties U.S. Drug Prices to Lowest Global Rates

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In May, the Trump administration published an executive order requiring drug companies to bring prices in line with those paid by other developed nations, otherwise known as Most Favored Nation (MFN) pricing. Although the June 11 deadline has come and gone, no details have been released as to whether drug companies have opted to negotiate or if the government will implement any enforcement action.

ACR Meets with Trump Administration to Discuss 2026 Physician Fee Schedule Proposed Rule

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Issues discussed at a meeting with the Office of Management & Budget included increasing Medicare reimbursement for physicians, telemedicine permanence, removing G2211 restrictions, adequate reimbursement for therapies and more flexibility for chemotherapy administration codes. The proposed rule is currently under review by the OMB, which is usually the last step prior to releasing publicly for stakeholder review and comment.

Arkansas Leads the Nation with Landmark Pharmacy Benefit Manager Reform

Joseph Cantrell, JD  |  

Signed into law in April, the legislation will ban direct and indirect PBM ownership of pharmacies, effective Jan. 1, 2026. It addresses longstanding concerns about conflicts of interest, market consolidation and patient access created by vertically integrated PBM pharmacy models.