In brief: Prior auth reform, diabetes spend, Medicare Trustees report
By HME News Staff
Updated 9:00 AM CDT, Mon June 23, 2025
WASHINGTON – Major U.S. health insurers have pledged six key reforms to prior authorization processes across Medicare Advantage, Medicaid Managed Care, the Health Insurance Marketplace and commercial health plans.
These reforms, announced by the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), aim to benefit nearly 80% of Americans covered by these plans.
Key prior authorization reforms announced
The initiative focuses on cutting red tape, accelerating care decisions, and enhancing transparency for both patients and healthcare providers. Participating insurers have committed to:
- Standardizing electronic prior authorization submissions using Fast Healthcare Interoperability Resources (FHIR)-based APIs.
- Reducing the number of services requiring prior authorization by January 1, 2026.
- Honoring existing authorizations during insurance transitions to ensure continuity of care.
- Improving transparency and communication around authorization decisions and appeals.
- Expanding real-time responses to minimize care delays, with most requests receiving real-time approvals by 2027.
- Ensuring clinical denials are reviewed by medical professionals.
“These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care,” said CMS Administrator Dr. Mehmet Oz. “We applaud these voluntary actions by the private sector, which is how these types of issues should be solved. CMS will be evaluating progress and driving accountability toward our shared goals, as we continue to champion solutions that put patients first.”
Industry-wide collaboration
The reforms were unveiled during a roundtable discussion on June 23, with participation from leading health insurers and organizations, including:
- Aetna, Inc.
- AHIP
- Blue Cross Blue Shield Association
- CareFirst BlueCross BlueShield
- Centene Corporation
- The Cigna Group
- Elevance Health
- GuideWell
- Highmark Health
- Humana, Inc.
- Kaiser Permanente
- UnitedHealthcare
Impact on patients and providers
According to AHIP, the national trade association for the health insurance industry, the reforms are expected to deliver significant improvements:
- For patients: Faster, more direct access to appropriate treatments and medical services, with fewer administrative hurdles.
- For providers: Streamlined workflows and a more efficient, transparent prior authorization process, enabling a stronger focus on delivering evidence-based care.
“The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike,” said AHIP President and CEO Mike Tuffin. “Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system.”
New report shows diabetes spending levels off as GLP-1 use, cost controls rise
SALT LAKE CITY – After decades of increases, diabetes-related health care costs have plateaued, according to a new Trends in Spend report from Nomi Health.
To build the report, the company analyzed employer-sponsored claims data from 2021-24 and found that, while overall health care costs continue to climb, diabetes costs have leveled off.
“For years, diabetes has been one of the biggest and fastest-growing costs for employers,” said Mark Newman, CEO and co-founder of Nomi Health. “Now that those costs are holding steady, it’s the right time to take a closer look at what’s working—and do more of it.”
Key findings from the report:
- Annual spend for diabetics increased just 11% from 2021-2024, while spend for non-diabetics jumped 15%.
- Average monthly medical spend for diabetics decreased slightly (0.5%), while non-diabetic medical spend surged 17%.
- Prescription growth for diabetics (34%) stayed well below the 57% spike for non-diabetics.
What’s driving the shift?
Three major trends:
- More people are using new GLP-1 drugs for diabetes and weight loss.
- Most PBMs now cap insulin costs at $35 per month.
- More employers are using diabetes programs that help people stay out of the hospital.
Nomi provided a cautionary note about GLP-1s, saying the drugs are costly over time and their health benefits may depend on continued use.
“Employers need a strategy,” it said.
The company says its integrated platform combines analytics, pharmacy management, direct provider networks and payment solutions – providing the infrastructure that power better health care for self-insured employers. It says it serves 4,000 customers nationwide, impacting 30 million lives and influencing more than $150 billion in health care spend.
Read the full report here.
Medicare spending projected to surge, outpace economic growth
WASHINGTON – Medicare expenditures are projected to grow significantly faster than both aggregate worker earnings and the overall U.S. economy, according to the 2025 Annual Report from the Boards of Trustees of the Federal Hospital Insurance (HI) and Federal Supplementary Medical Insurance (SMI) Trust Funds.
Key findings from the 2025 Medicare Trustees Report
- Medicare spending as a share of GDP is expected to rise from 3.8% in 2024 to 6.7% by 2099.
- Under an alternative scenario with higher healthcare cost growth, Medicare could consume up to 8.8% of GDP by 2099.
- This growth trajectory poses a serious challenge to Medicare’s financial sustainability, the federal budget, and economic stability.
“The projections in this report show that change is needed to address Medicare’s financial challenges,” the trustees stated. “The sooner solutions are enacted, the more flexible and gradual they can be.”
Financial outlook for Medicare Trust Funds
- The HI Trust Fund is projected to run a deficit starting in 2027, failing both short-term and long-term financial adequacy tests.
- The SMI Trust Fund (covering Medicare Part B and Part D) is expected to remain solvent due to annual adjustments in premiums and government contributions. However, these adjustments will need to outpace economic growth to meet rising costs.
Medicare expenditures in 2024
In 2024, total Medicare expenditures reached $1.12 trillion, underscoring the scale of the program and the urgency of reform.
Read the 267-page report here.
InfuSystem, Apollo Medical Supply join forces
ROCHESTER HILLS, Mich. – InfuSystem Holdings has acquired Apollo Medical Supply, according to a post on LinkedIn. “We look forward to this next chapter as we join forces to expand and accelerate our wound care solutions,” the company stated in the post. “This partnership brings new opportunities for innovation, growth and collaboration while supporting our mission of helping people live longer and healthier lives.” InfuSystem has a two-platform model: Its Patient Services segment is comprised of oncology, pain management and wound therapy businesses; and its Device Solutions segment is comprised of direct payer rentals, pump and consumable sales, as well as biomedical services and repair. For the first quarter ended March 31, 2025, InfuSystem reported $20.8 million in net revenue for Patient Services, a 12% increase year over year; and $13.9 million in net revenue for Device Solutions, a 4% increase year over year. Apollo Medical Supply is a Casselberry, Fla.-based provider of wound care products and supplies, including collagen pads/gels/powders and alginates with and without silver.
Lifeway Mobility buys Center Span, Redispan & enters NYC market
HARTFORD, Conn. – Lifeway Mobility has acquired Deer Park, N.Y.-based Center Span, a national provider of home safety and accessibility products serving veterans and people with limited mobility, and Redispan, a manufacturer of patented wheelchair ramps. With this acquisition, Lifeway initiates service to customers throughout the New York City metropolitan area and expands coverage to more than 35 states nationwide. “We’re proud to welcome the Center Span team into the Lifeway family,” said Paul Bergantino, CEO of Lifeway Mobility. “This acquisition is more than a strategic step forward — it’s a union rooted in a shared mission to serve the millions of Americans with physical and mobility limitations, including the veterans who have served our country. Together, we’re strengthening our commitment to veterans, deepening our culture of customer service, and expanding our capacity to reach more customers in need. The Lifeway and Center Span teams share values and commitment to integrity, excellence, and purpose, and we’re excited for what we’ll accomplish together.” In addition to Redispan, its proprietary line of wheelchair ramps, Center Span will continue to offer a variety of accessibility solutions to veterans through contracts with the Veterans Affairs health system in more than 22 states. Center Span’s experienced teams will continue in their current roles and Center Span’s Co-Founders, Kathie and Ed Finnegan, will join Lifeway’s leadership team. “Accessibility has always been more than a business for us — it’s a personal mission,” said Kathie and Ed Finnegan. “We’re incredibly proud of the established accessibility company we’ve built over the last 15 years and the innovative modular ramp system we developed to better serve veterans and others in need. Through our work with VA centers across the country, we’ve seen the positive impact of accessibility solutions in improving the lives of the customers we serve, and we’re excited to continue that mission and passion with Lifeway. The Center Span teams look forward to growing together with Lifeway, both nationally and throughout the NYC metro area, with the same, shared mission – to help people improve their independence, mobility and safety at home.” Center Span and Redispan will continue to operate under their current company names and to serve customers from their location in Deer Park.
Inogen-Yuwell launch new stationary oxygen concentrator
GOLETA, Calif. – Inogen has launched Voxi 5, a new stationary oxygen concentrator developed in collaboration with Yuwell Medical. Inogen says the Voxi 5 augments its line of portable oxygen concentrators, significantly expanding its market potential and leveraging its existing sales channel. “With Voxi 5, we are fulfilling our mission to make respiratory care more accessible and empowering for patients,” said Kevin Smith, president and CEP. “This launch exemplifies our commitment to innovation, affordability, and enhancing the quality of life for those dependent on oxygen therapy.” Inogen entered into a strategic collaboration with Yuwell earlier this year. Inogen says Voxi 5 presents a viable option for patients seeking reliable stationary oxygen therapy, delivering 1-5 L/min of quiet, pure, continuous flow oxygen in a compact and efficient design. It says the device also features caster wheels to allow for worry free movement between rooms in the home, providing enhanced mobility and ease-of-use.
- Related: Inogen expects ‘positive margin’ from Yuwell.
Are you ready for catheter code changes?
YARMOUTH, Maine – Coloplast and ACU-Serve are teaming up on a webcast to help providers prepare for upcoming intermittent catheter HCPCS code changes. On Jan. 1, CMS will modify two existing codes and add three new codes to differentiate catheters with a hydrophilic coating. The free webcast, on July 15th at 12:00 p.m. EST, will discuss:
- The importance of internal and payer education
- The impact of hydrophilic catheters
- The clinical and economic benefits of hydrophilic coated catheters
- The important next steps for preparing for the changes
To register for the webcast, go here.
- Related: AAHomecare launches resources for new cath codes
- Related: Catheter proposal is ‘huge step forward’
- Related: PDAC preps for new cath codes
United Spinal hosts lobby day
WASHINGTON – United Spinal Association will bring nearly 200 wheelchair users and allies to Washington, D.C., for its signature advocacy event, Roll on Capitol Hill, June 22-25. As national policymakers contemplate budget proposals that could slash Medicaid, weaken civil rights protections and roll back vital social programs, ROCH arrives at a time when people with disabilities must find common ground and push back on these escalating attacks, the association says. “Roll on Capitol Hill stands as a powerful call to action,” said Vincenzo Piscopo, United Spinal Association president/CEO. “We are sending a clear message to lawmakers: The uncertainty surrounding Medicaid and other critical policies is unacceptable. Guarantees of our security and other positive changes can no longer wait, and advocacy is how we shape that change. If not now, then when? If not us, then who?” United Spinal’s extensive Grassroots Advocacy Network, comprising more than 2,600 wheelchair users across nearly every congressional district, has more than doubled in size over three years. ROCH provides them a powerful platform to unite, strategize and consolidate national campaigns for ordinary citizen-advocates. “Roll on Capitol Hill is the ultimate expression of United Spinal's year-round advocacy program,” said Stephen Lieberman, senior director of advocacy & policy. “Wheelchair users sharing their stories and illustrating the impacts of the decisions our policymakers make is what advocacy is all about.”
Happy Health opens ‘new frontier’ in care delivery
AUSTIN, Texas – Happy Health has announced that the U.S. Food and Drug Administration has cleared the Happy Ring as a class II medical device to facilitate the diagnosis of obstructive sleep apnea, insomnia and other sleep-related conditions in the home. This new clearance builds on the Happy Ring's earlier FDA clearance for comprehensive, continuous brain and body biometrics, making it the only FDA-cleared smart ring that combines multi-night sleep testing (97% accurate to gold standard PSG) with 24/7 physiologic monitoring, the company says. “Sleep is the foundation of health and the 'canary in the coal mine' of disease," said Dustin Freckleton, MD, founder and CEO of Happy Health. "When we measure sleep accurately in people's 20s, 30s and 40s, we expose the patterns that drive heart disease, hypertension and metabolic and behavioral disorders decades later. This clearance is just the beginning. Our sensor-rich ring will be diagnosing those comorbid conditions next, in the very near future. The best is yet to come." Through the Happy Sleep platform, individuals order a sleep test online, wear the ring overnight and review the results with a board-certified sleep physician – all in the comfort of their own home. During the visit, patients create an individualized treatment plan with their provider—ranging from the gold-standard CPAP to PAP-alternative dental appliances to the newest FDA-approved GLP-1 therapies such as Zepbound—so patients move from testing to the right solution without ever leaving home. These services are covered by most major U.S. insurers, the company says. "Happy Ring is much more than a sleep device," said Jeff Durmer, MD, PhD, neurologist and advisor to Happy Health. "It brings hospital-level insights to any bedroom, opening a new frontier for how we deliver care. By expanding access, elevating diagnostic quality, and lowering total cost, this technology reshapes not only sleep medicine but the broader practice of medicine for patients everywhere."
Tandem integrates, partners with Abbott
SAN DIEGO – Tandem Diabetes Care has announced that the Tandem t:slimX2 insulin pump with Control-IQ+ automated insulin delivery (AID) technology now works with Abbott’s FreeStyle Libre 3 Plus continuous glucose monitoring (CGM) sensor. The company has initiated an early access program in the United States and intends to scale availability in the second half of 2025. “Diabetes management is not one-size-fits-all and it is critical for people living with diabetes to be able to personalize their AID systems to fit their unique healthcare and lifestyle needs,” said Dr. Jordan Pinsker, chief medical officer of Tandem Diabetes Care. “The American Diabetes Association recommends AID systems as the preferred insulin delivery method in people with type 1 and other types of insulin-deficient diabetes, and this integration with Abbott’s latest generation sensor allows even more CGM users to access the life-changing benefits of our Control-IQ+ technology.” Tandem has also announced an agreement to develop and commercialize integrated diabetes solutions that combine Abbott’s future dual glucose-ketone sensor with Tandem’s insulin delivery systems to provide more options for people to manage their diabetes. The Abbott sensor, currently under development, will combine glucose and ketone sensing technology that aims to help people living with diabetes detect early ketone rise to avoid life-threatening diabetic ketoacidosis. "Integrating our advanced insulin delivery systems with Abbott’s future glucose-ketone sensor has the potential to help empower people with diabetes to take faster, more informed action to protect their health and improve outcomes," said John Sheridan, president and CEO. "We are excited to continue our partnership with Abbott and look forward to working with them to bring this new integration to customers in the future."
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