Insights

On April 10, 2026, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (2026 CMS Interoperability Standards and Prior Authorization for Drugs, or CMS-0062-P) outlining the agency’s plans to impose new interoperability requirements on payors participating in certain Medicare and Medicaid programs. As described by the agency in a recent press release, the proposed rule “builds on” prior rulemaking by clarifying and enhancing interoperability requirements for payors’ prior authorization processes, specifically those associated with coverage requests for pharmaceutical therapies.

As pharmaceutical weight-loss therapies have surged in popularity, health plans, regulators, and courts have found themselves grappling with a set of increasingly pressing and complex questions: who must cover these drugs, under what circumstances, and for whom?

On February 20, 2026, the Department of Justice’s Antitrust Division (DOJ) and Ohio Attorney General (Ohio AG) sued OhioHealth Corporation (OhioHealth), alleging that OhioHealth had unlawfully restrained trade in the market for general acute care inpatient hospital services in the Columbus metropolitan statistical area and the narrower Central Columbus area, respectively. The DOJ and Ohio AG allege violations of Section 1 of the Sherman Act, as well as the Valentine Act (Ohio’s antitrust statute), claiming that OhioHealth leveraged its market power to impose contractual restrictions that blocked payors from working with competing health systems to design “budget-conscious” lower-cost health plans.