Regulatory & Compliance

CMS just dropped the long-anticipated drug prior authorization proposed rule. Here's what every health plan and PBM operations leader needs to know, without the regulatory jargon.

CMS-0057 compliance is the starting line, not the finish line — and CMS-0062 is already on the way. Here’s the question health plan leaders should be asking right now.

Washington has enacts a comprehensive law designed to modernize prior authorization practices in response to longstanding prior authorization concerns.

PBM pricing transparency reforms are forcing pharmacy benefit managers to modernize clinical and compliance workflows, making operational readiness a critical competitive advantage rather than a regulatory checkbox.

California’s SB 41 is putting prior authorization under direct regulatory scrutiny starting in 2026–2027, and Banjo Health helps plans and PBMs stay compliant with audit-ready, evidence-based, faster PA automation and reporting.

Automated, compliant letter generation that saves case managers time, eliminates errors, and ensures the right message reaches the right stakeholder—every time.