Insurance

To mark the 30th anniversary of The American Journal of Managed Care, each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The November issue features a conversation with Laurie C. Zephyrin, MD, MPH, MBA, senior vice president for achieving equitable outcomes at the Commonwealth Fund. This interview has been edited for length and clarity.

Utilizing the Health Insurance Disparities Index for assessment, the authors found that New York’s Medicaid health maintenance organizations (HMOs) outperformed Medicaid HMOs nationally in addressing health care disparities from 2019 to 2023.

Only 4% of NIH prevention projects target health disparities, revealing a major gap between equity research and real-world implementation.

The introduction of more stringent work requirements for those enrolling or renewing their Medicaid coverage can affect both children and adults.

Medicare Advantage plans that place greater restrictions on home health agency care delivery may have more adverse patient outcomes than plans that provide episodic payments.

As open enrollment begins November 1, 2025, millions are signing up under enhanced subsidies that are set to expire at the end of this year.

Individuals with both low incomes and health problems were more likely to gain employment when covered by Medicaid.

PBM legislation is rising nationwide, which experts emphasize could increase costs and hinder patient care.

Premiums for coverage on the ACA marketplaces are set to jump by an average of 26% next year, even before the expiration of subsidies is factored in.

The antiretroviral (ART) regimen Biktarvy showed higher 1-year ART persistence and lower switch rates among people with HIV.

In the midst of a government shutdown, former House Speaker Paul Ryan urges clear policies, AI innovation, and patient-focused solutions to build a sustainable US health care system.

AI can transform health care by processing vast data, enhancing decision-making, and addressing biases, but needs remain for transparency and human oversight.

Ratna Kiran Bhavaraju-Sanka, MD, and Beth Stein, MD, advocate for improved proactive management of myasthenia gravis (MG) for better patient outcomes.

New research highlights rising opioid use disorder (OUD) diagnoses among youth, emphasizing the need for improved screenings and mental health support.

The AMCP Nexus 2025 conference will bring together professionals to discuss drug access and policy, as well as the future of pharmacy.

Liver Awareness Month raises awareness of liver disease causes, risks, symptoms, and prevention, highlighting individual actions and policy efforts.

Medicare Advantage grocery supplemental benefit use is associated with increased outpatient care, suggesting that policy changes allowing for nonmedical supplemental benefits could improve beneficiaries’ health, especially for dual-eligible beneficiaries.

Counseling patients with obstructive sleep apnea on using GLP-1s effectively prior to starting treatment can help ensure adherence, said Matthew Biszewski, PharmD.

Adults with diabetes were 24% less likely to visit an emergency department in 2021 than in 2019.

Payer contracts should incentivize the delivery of comprehensive, total-person cancer care, says Brian Mulherin, MD.

Infliximab biosimilars created price competition causing insurance claims costs for infliximab originator and infliximab biosimilars to decrease, generating significant savings to the health care system.

Despite systemic challenges, oncology practices use value-based care, community partnerships, and clinical trials to improve patient access and outcomes, says Brian Mulherin, MD.

Lindsey Valenzuela, PharmD, explains how cost, coverage gaps, and tech literacy hinder women’s access to early arrhythmia detection tools.

Robert Andrews, CEO of the Health Transformation Alliance, addresses Medicaid rebates, cost-shifting concerns, and value-based pricing trends.

Robert Andrews, CEO of the Health Transformation Alliance, discusses the implications of the new TrumpRx platform on drug pricing policy.

Research reveals that Medicaid accountable care organization (ACO) designs significantly impact maternal health outcomes, highlighting the importance of structural partnerships in care delivery.

Rilzabrutinib (Wayrilz; Sanofi) may improve immune thrombocytopenia (ITP) outcomes, enable early intervention, and enhance patient quality of life.

Prior authorizations for health plans will soon implement AI to streamline the process and potentially improve patient outcomes.

Today, Amgen announced the launch of AmgenNow, a direct-to-patient program offering evolocumab (Repatha) at nearly 60% below the current US list price.

This article examines how prices, insurer payments, and patient payments for outpatient surgeries differ by site of care and network status.