Industry Leaders Applaud CMS’s Measured Approach
Insurance industry representatives have expressed strong support for the Centers for Medicare & Medicaid Services’ (CMS) final rule for Medicare Advantage (MA) in 2026, highlighting the administration’s balanced approach to program changes. The rule addresses several key areas while stepping back from some of the more controversial proposals that had been under consideration.
Better Medicare Alliance Endorses Decision
In a statement released on April 4, Better Medicare Alliance President Mary Beth Donahue characterized the rule as the “right decision to protect seniors and the Medicare Advantage program.”
“As we continue to review the final rule, we are encouraged that the Administration took a measured approach and declined to make major changes at this time,” Donahue remarked.
The Better Medicare Alliance, an organization backed by several major insurance companies, has consistently advocated for policies that maintain stability in the Medicare Advantage marketplace while supporting beneficiary access to care.
Weight Loss Medication Coverage Decision
One of the most significant aspects of the final rule was the decision not to require Medicare Advantage plans to cover GLP-1 drugs for weight loss. The Biden administration had initially proposed mandating this coverage in its November proposal, a move that analysts projected would increase federal spending by approximately $35 billion over a ten-year period.
The Trump administration ultimately decided against implementing this requirement, though CMS indicated that the decision could be revisited in future rulemaking processes as more data becomes available about the long-term efficacy and economic impact of these medications.
ACHP Commends Weight Loss Drug Decision
The Alliance of Community Health Plans (ACHP), which represents provider-sponsored health plans, specifically praised the decision regarding weight loss medications in their April 4 statement.
“While these drugs offer hope for many, the excessive costs carry enormous consequences for consumers, taxpayers and employers,” said ACHP President and CEO Ceci Connolly. “ACHP was the leading national payer organization to speak out against the proposed expansion, which would have been irresponsible without further long-term efficacy and safety studies and economic analysis.”
AI Regulation Postponed for Further Study
Another notable decision in the final rule was to delay implementation of stricter regulations concerning the use of artificial intelligence in prior authorization decisions.
The initial proposal had suggested adding regulatory guardrails around AI utilization in these processes, but the administration opted not to finalize these rules at this time. CMS stated that it will continue to evaluate potential regulatory approaches to artificial intelligence in healthcare decision-making and may address this issue in future rulemaking.
Industry Implications and Future Outlook
The final rule reflects a cautious approach to Medicare Advantage regulation, prioritizing program stability while still acknowledging areas that may require future attention. Insurance providers can now proceed with their 2026 planning with greater certainty about regulatory requirements.
Health policy experts note that the decisions on both GLP-1 coverage and AI regulation demonstrate the administration’s commitment to thorough analysis before implementing significant changes that could impact healthcare costs and delivery systems.
As Medicare Advantage continues to grow in popularity among seniors, with enrollment now exceeding traditional Medicare in many markets, these regulatory decisions will have far-reaching implications for healthcare access and affordability for millions of Americans.
Discover the latest payers’ news updates with a single click. Follow DistilINFO HealthPlan and stay ahead with updates. Join our community today!
