Federal Watchdog Will Examine How Medicare Advantage Plans Require Prior Authorization for Doctor-Administered Drugs

The Department of Health and Human Services Office of Inspector General announced September 15 that it will evaluate how Medicare Advantage organizations use prior authorization for drugs covered under Medicare Part B. The project is assigned number OEI-05-26-00250. Part B drugs are medicines administered in a clinical setting, such as infused treatments for cancer or injected therapies for autoimmune conditions. Unlike Part D drugs, which patients pick up at a pharmacy, Part B drugs are given directly by a physician or clinical staff. In Original Medicare, prior authorization requirements for Part B drugs are uncommon. Medicare Advantage plans, which are private alternatives to Original Medicare, may impose additional approval steps before a patient receives these treatments. The OIG has published multiple recent reports on prior authorization in Medicare Advantage, including a 2026 finding that plans overturned 95 percent of appealed denials for skilled nursing facility stays. This new evaluation focuses specifically on doctor-administered drugs rather than post-acute care. A work plan addition does not indicate that the OIG has found problems. A formal report with findings and any recommendations will follow at a later date.