Insurance

To mark the 30th anniversary of The American Journal of Managed Care (AJMC), 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 August issue features a conversation with Charles N. (Chip) Kahn III, MPH, the president and CEO of the Federation of American Hospitals and a longtime member of the AJMC editorial board.

At the recent regional Institute for Value-Based Medicine® event in Boston, Anasuya Gunturi, MD, PhD, Lowell General Hospital, was a panelist for the discussion, “Evolving Breast Cancer Care: Addressing Unmet Needs Across the Patient Journey.”

Patients who experienced a formulary-related rejection of cariprazine for adjunctive treatment of major depressive disorder had significantly higher hospitalization rates than those with approved claims.

Mental health, care of acute and chronic conditions, primary care access and prevention, and maternal and perinatal health were identified as key focus areas among a majority of states.

There is a great need to streamline the process from the tissue sample to the diagnostic lab, whether it's genomic or immunohistochemistry, Robert Kratzke, MD, says.

According to the American Medical Association, blame for the ongoing physician shortage may lie with overly burdensome administrative processes, an antiquated Medicare payment system, and lack of education for residents in primary care and psychiatry.

Revumenib is now the sole targeted therapy recommended by the National Comprehensive Cancer Network for KMT2A-rearranged acute leukemia, which opens a path for payers, said Ivo Abraham, PhD, RN, of The University of Arizona.

Apixaban would still cost patients 9 times more through the Eliquis 360 Support program than with commercial insurance.

Robert Kratzke, MD, urged insurance providers to prioritize fast biomarker testing in non–small cell lung cancer, saying it’s both cost-effective and life-saving.

Medicare inflation rebates fail to curb rising drug prices, highlighting the need for further policy action to control costs.

A webinar held by KFF on July 9 emphasized the immediate effects of the new budget bill, highlighting the impacts on Medicaid and health spending in the next decade.

Families caring for individuals with Duchenne muscular dystrophy (DMD) face significant financial burdens from necessary home and vehicle modifications to enhance quality of life.

Access to and affordability of immune checkpoint inhibitors, which can be lifesaving if patients receive them on time and under optimal circumstances, continue to top the list of reasons behind outcomes disparities for patients who have private insurance vs those who remain uninsured.

From the impact of rising grocery prices to disparities in myeloma outcomes, check out news from the Center on Health Equity & Access this past week.

The decision by the Supreme Court has major implications on which preventive services are required to be covered by insurance companies under the Affordable Care Act.

Several evidence-based health literacy resources may be beneficial in health plan settings to improve organizational health literacy, personal health literacy, and health equity.

Up to 257 million Americans could benefit from these prior authorization reforms that could have cross-market implications on health care plans administered through commercial insurers, Medicare Advantage, and Medicaid.

Widespread noncompliance with federal cost-sharing rules exists, particularly impacting Medicare beneficiaries and patient-preferred prep options, study finds.

The recent FDA approval of lenacapavir is encouraging in its promise of long-term HIV prevention but might not be available for the vast majority of people in the US.

The Choose Medicare Act would establish a Medicare Part E that would give employers and the general public the ability to opt into the program.

Real-world cost barriers and insurance denials contribute to early discontinuation of injectable glucagon-like peptide-1 (GLP-1) receptor agonists, reducing their effectiveness for weight loss, explains Hamlet Gasoyan, PhD, Cleveland Clinic.

Supported value-based care improves prenatal care while reducing neonatal intensive care unit stays, preterm birth rates, low birth weight rates, and costs for mothers and infants.

A private oncology shared savings plan reduced colon cancer treatment costs. Results varied by tumor, with none in breast cancer and mixed effects in lung cancer.

Constance Blunt, MD, medical oncologist, Mary Bird Perkins Cancer Center, discusses the potential consequences of losing free health care screening coverage.

Patients who remained on treatment, especially at higher doses or on tirzepatide, were more likely to achieve clinically meaningful weight loss and improved glycemic control.

Adolescents face significant barriers to obesity medication access, despite a surge in prescriptions. Discover the disparities and potential solutions in obesity care.

Accessing medical and social resources for patients, heavy administrative burden, and lack of data integration are barriers to Medicaid managed care organization care coordinators’ job performance.

David Awad, PharmD, BCOP, says pharmacists play a growing role in managing access, safety, and toxicity for these therapies, ensuring treatments are appropriate and sustainable in real-world oncology practice.

Rural marketplace rating area change in Texas did not increase enrollment but increased share of enrollment in gold plans.

Constance Blunt, MD, medical oncologist, Mary Bird Perkins Cancer Center, shares how one mobile health care initiative is addressing critical barriers to medical access for underserved populations.