April 2, 2026

The Centers for Medicare and Medicaid Services launched the WISeR pilot, which uses AI-backed prior authorization in traditional Medicare to reduce low-value care, but it has drawn criticism for potentially delaying treatment and increasing administrative burden. A lawsuit by the Electronic Frontier Foundation claims the model lacks transparency, may introduce bias, and is already causing harm, while also alleging CMS violated public records law by failing to release requested information.

CVS plans to expand pharmacy-only locations nationwide to improve access to essential pharmacy services. Each site will include a full-service pharmacy along with a tailored selection of over-the-counter products. This move is part of the company’s broader effort to reshape its pharmacy business and realign its retail footprint to better meet patient needs and adapt to changes in the industry.

Earlier this year, CMS notified Elevance that it planned to block its Medicare Advantage plans from enrolling new members and impose additional sanctions beginning March 31. Following the extension, Elevance now has until May 30 to correct its data before penalties take effect. The revised timeline gives both Elevance and CMS more time for technical discussions and allows the insurer to submit required corrections through CMS’s official electronic systems.

Filed Monday, the lawsuit seeks to overturn the 2023 rule and require recalculation of Disproportionate Share Hospital (DSH) payments. These payments are intended to offset the financial burden of treating large numbers of uninsured, low-income, and Medicaid patients. However, the methodology used to calculate DSH payments has long been contentious and remains a frequent source of litigation.

A bipartisan group of senators is urging the Centers for Medicare & Medicaid Services to go further in addressing overpayments in Medicare Advantage by tightening rules around how diagnoses are used for reimbursement. While they support a proposal to exclude certain chart review diagnoses, they argue additional reforms are needed to curb upcoding, which contributes to billions in excess government spending each year.