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Dual and Triple Agonists Tirzepatide (Mounjaro/Zepbound) Tirzepatide is the first true dual or co-agonist, activating both GLP-1 and GIP receptors, a pairing often called a twincretin
Hexarelin does this through a calcium/PKC cascade while blunting somatostatin's inhibitory signal, and Ipamorelin is considered more selective because it does not meaningfully raise cortisol or prolactin alongside GH
Already in effect (January 1, 2026): Standard PA decisions within 7 calendar days (down from 14) Urgent PA decisions within 72 hours Specific denial reasons required on every denial (not just not medically necessary) Applies to Medicare Advantage, Medicaid managed care, CHIP, and ACA Marketplace plans Coming March 31, 2026: Payers must publicly report PA metrics for calendar year 2025: approval/denial rates, average decision times, and appeals outcomes Providers will be able to compare payer performance for the first time Coming January 1, 2027: FHIR-based Prior Authorization APIs required providers check PA requirements, submit requests, and receive decisions electronically through their EHR Expected to reduce average PA processing time from days to minutes for standard requests Medicare WISeR Model (live in AZ and WA): The Wasteful and Inappropriate Services Reduction pilot launched January 2026 in six states including Arizona and Washington
