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September 1, 2022

Around the nation: CMS suspends prior authorization requirements for certain services

Daily Briefing

    CMS has suspended prior authorization requirements for specific medical equipment under certain circumstances, in today's bite-sized hospital and health industry news from Maryland and New York.

    • Maryland: CMS has suspended prior authorization requirements for specific prosthetics and orthotics prescribed under certain circumstances. In addition, supply codes will be suspended in certain situations. According to CMS, prior authorization requirements have been indefinitely suspended for patients who urgently need to receive an orthoses item and cannot wait for the two-day expedited review without putting their life or health at risk. (Norris, HealthLeaders Media, 8/29)
    • Maryland: FDA's Adverse Event Reporting System (FAERS) identified 36 cases of acute gallbladder disease in individuals who were prescribed glucagon-like peptide-1 (GLP-1) receptor agonists for diabetes or weight loss. Between 2005 and 2016, 21 cases were identified in patients taking exenatide, seven cases in patients taking dulaglutide, seven cases in patients taking semaglutide, and one case in a patient taking lixisenatide, Danial Woronow his FDA colleagues said. Notably, their report supports the findings of a recent meta-analysis, which found an association between cholecystitis and GLP-1 receptor agonists. Prescribing information for GLP-1 receptor agonists "has recently been revised to include warnings and precautions about this risk," the group noted. (Hamza, MedPage Today, 8/30)
    • New York/Florida: A partnership between Oscar Health and Health First Shared Services, which was announced at the beginning of 2021, will be terminated as early as January. In a Securities and Exchange Commission (SEC) filing, Health First Shared Services on Tuesday said it "has indicated that it intends to terminate the agreement and transition the services from +Oscar to HF, effective as early as January 1, 2023." Notably, Health First was the first company to purchase Oscar Health's technology services—a deal that was expected to generate $60 million in revenue in 2022.(Tepper, Modern Healthcare, 8/30)

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