Struggling with low energy levels
Already in effect (January 1, 2026): Standard PA decisions within 7 calendar days (down from 14) Urgent PA decisions within 72 hours Specific denial reasons required on every denial (not just not medically necessary) Applies to Medicare Advantage, Medicaid managed care, CHIP, and ACA Marketplace plans Coming March 31, 2026: Payers must publicly report PA metrics for calendar year 2025: approval/denial rates, average decision times, and appeals outcomes Providers will be able to compare payer performance for the first time Coming January 1, 2027: FHIR-based Prior Authorization APIs required providers check PA requirements, submit requests, and receive decisions electronically through their EHR Expected to reduce average PA processing time from days to minutes for standard requests Medicare WISeR Model (live in AZ and WA): The Wasteful and Inappropriate Services Reduction pilot launched January 2026 in six states including Arizona and Washington
Nozawa, H., Chiu, C
As discussed further below, we did not propose an additional reduction beyond the 1.0 percentage point reduction required by section 16002(b) of the 21st Century Cures Act for CY 2026
Step 1: Consultation Meet with a provider who works with peptides
FSA tax benefits are administered by your job
