Health Care Cost

This commentary, part of the Price Crisis campaign, focuses on the role of employers and business coalitions in advocating for policy change.

To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes reflections from a thought leader on what has changed over the past 3 decades and what’s next for managed care. The May issue features a conversation with John Michael O’Brien, PharmD, MPH, a member of AJMC’s editorial board and the president and CEO of the National Pharmaceutical Council. This interview has been lightly edited for clarity.

An executive order signed on Tuesday, March 15, necessitated a change in plans for this panel discussion from the 2025 Community Oncology Conference, with the assembled experts, moderated by Ted Okon, MBA, executive director of the Community Oncology Alliance, speaking to how the order would reverberate across the community oncology space.

Approximately 1 million Aetna members will need new coverage with the announcement that CVS will be leaving the Affordable Care Act (ACA) individual exchange business next year.

Experts urge for technology-driven, collaborative solutions as patients shoulder a growing burden of prescription costs.

As the number of cell and gene therapies expands, it's increasingly important for long-term patient data, explained Fran Gregory, PharmD, MBA, vice president of emerging therapies at Cardinal Health.

New treatments for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) enhance patient care with gene therapies and new mechanisms of action on the horizon, explained Casey Koch, PharmD, from Select Health.

Evaluating the impact of the Inflation Reduction Act (IRA) will require real-time data and effective therapy metrics, explained H. John Beardsley, MBA, of CoverMyMeds; and Fauzea Hussain, MPH, of McKesson.

Medicaid beneficiaries face higher rates of pulmonary hypertension, with significant economic burdens and racial disparities in prevalence and costs.

When it comes to treating multiple myeloma (MM), Ajai Chari, MD, argued that more is not always better. More intense treatment regimens, or those with more drugs, don't necessarily guarantee better outcomes.

The Trump administration is proceeding with probes into the national security implications of pharmaceutical imports.

Substantial savings opportunities exist by using lower-cost biologics for patients with plaque psoriasis, according to one study.

Asembia's AXS25 Summit will unite more than 8000 key decision-makers to explore pharmacy innovation, artificial intelligence, policy, and patient care from April 27 to May 1 at Wynn & Encore in Las Vegas, Nevada.

Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.

Jaime Almandoz, MD, MBA, of UT Southwestern Medical Center, speaks on results of a study that investigated tirzepatide uptake trends in commercial claims data.

An analysis of an interdisciplinary care model for managing chronic kidney disease (CKD) shows hospital admissions dropped by 26% and emergency department (ED) visits decreased by 30% after clinic initiation.

This week, the Center on Health Equity & Access covered artificial intelligence, diabetes clinical trials, racial disparities in cancer antigen thresholds, and more.

Richard Hughes IV, JD, MPH, spoke about the upcoming oral arguments to be presented to the Supreme Court regarding the Braidwood case, which would determine how preventive services are guaranteed insurance coverage.

Sam Peasah, PhD, MBA, RPh, director of High-Value Health Care Value-Based Pharmacy Initiatives at UPMC Health Plan, discusses ways that health plans can help reduce the cost burden of medications to improve adherence.

As drug denials increase, experts discuss the importance of optimizing data to keep up with these changes and implementing artificial intelligence (AI) to reduce the burden on providers and ensure patient access to care and treatment.

The executive order targets lower drug prices through Medicare reforms, anticompetitive crackdowns, and transparency mandates.

JC Scott, CEO and president of The Pharmaceutical Care Management Association, discusses current efforts in increasing biosimilar adoption and pharmacy benefit manager (PBM) reform.

From the potential impact of tariffs to the World Health Organization's year-long campaign launch focused on improving maternal and newborn health and addressing preventable deaths, here's the latest from the Center on Health Equity & Access.

Neha Kashalikar, PharmD, director of strategic pharmacy consulting at MassHealth, breaks down the outcome measures often used in pharmacy and medical claims to evaluate the performance of value-based contracts.

A series of new studies from the National Kidney Foundation Spring Clinical Meeting exhibit the association between impaired kidney function and prolonged hospital stays, higher charges, and greater resource utilization.

A new technology for management of diabetes is cost-effective for patients in the US with type 1 diabetes compared with traditional treatments.

Adam Colborn, JD, associate vice president for congressional affairs, Academy of Managed Care Pharmacy, highlights key policy updates that are impacting managed care pharmacy.

Taxing imports to the US could spell major consequences for health care prices, innovation, and access, as a great amount of medical supplies and ingredients are manufactured overseas.

The Center on Health Equity & Access delves into the latest policy shifts, research, and expert perspectives on advancing equity and improving access to care.

In 2021, UnitedHealth Group received 42% of the $33 billion in additional Medicare Advantage payments from differential coding.