Policy

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 October issue features a conversation with Ge Bai, PhD, CPA, professor of accounting at Johns Hopkins Carey Business School and professor of health policy and management at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

The US government shutdown could lead to telehealth, ambulance payment, and insurance cost disruptions.

The Trump administration advances the Most Favored Nation order by partnering with Pfizer, which came to the table voluntarily and has been granted a reprieve from upcoming drug tariffs.

Experts at the ERS Congress 2025 highlighted threats to scientific integrity from misinformation, political interference, and predatory publishing in health research.

Laxmi Patel explains how providers can meet potential new Medicaid documentation requirements without harming patient access.

A RAND report shows Medicare’s 3-year insulin savings model cut costs, improved access for beneficiaries, and offers lessons for future drug pricing reforms.

Explore cutting-edge discussions on patient-centered oncology, value-based care, AI innovations, and survivorship strategies Thursday and Friday at PCOC 2025 in Nashville.

Proposed Medicaid cuts threaten children's health coverage, exacerbating existing gaps and impacting access to care for vulnerable populations.

The Trump administration highlighted a potential autism risk from prenatal acetaminophen use, but studies demonstrate conflicting evidence.

With vaccination rates slipping and new policies emerging, parents need to know what’s changing as kids head back to the classroom.

Susan Monarez, PhD, warns of absent evidence, political pressure, and risks to public health after being fired last month by HHS Secretary Robert F. Kennedy Jr.

The Rural Health Transformation Program invests $50 billion to enhance health care access and quality in rural America.

A secret shopper survey (N = 8306) in Pennsylvania’s Affordable Care Act (ACA) Marketplace found inconsistencies between carrier regulatory filings and provider directories, frequent inaccuracies in regulatory filings, and challenges in securing timely appointments.

This study examines the impact of the Affordable Care Act (ACA) on substance-associated emergency department (ED) visits among young adults, revealing reduced alcohol-associated visits but unchanged opioid-associated visits.

In a recent webinar, experts explored the Most Favored Nation mandate’s implications on drug pricing, patient access, and pharmaceutical innovation.

Participating hospitals in the Prime Vendor Program and the 340B program spent nearly $37.3 billion more on drugs from 2010 to 2021.

This case study describes Tennessee’s process for convening key stakeholders to develop uniform payment guidelines to encourage increased preventive service delivery.

This article presents a case study of how stakeholders in one state came together to integrate practice and research that is a step beyond a learning health care system.

FDA intensifies efforts against misleading drug advertisements, aiming for transparency and accountability in pharmaceutical marketing practices.

New guidelines and advocacy enhance myasthenia gravis treatment access, promoting proactive management and improved insurance coverage for diverse patient populations.

Panelists at the Community Oncology Alliance Payer Exchange Summit discuss the urgent need for innovative reimbursement models in cancer care to match advancements in biomedical technology and drug discovery.

Many states are enacting restrictions on insurers’ prior authorization policies, but these laws may increase costs and lead to other undesirable consequences.

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 September issue features a conversation with Dora Hughes, MD, MPH, chief medical officer and director of the Center for Clinical Standards and Quality at CMS.

The governors of Washington, California, and Oregon have launched the West Coast Health Alliance to provide evidence-based guidance amid shifting CDC policies.

Why is health care so staggeringly difficult to use? How do we fix it? To move forward, we first must look back, because the system we have today was not really designed, it evolved, notes Ariela Simerman, Turquoise Health.

Chris Johnson, MBA, emphasizes that the constantly shifting landscape of Medicaid could further confuse both patients and health care providers, potentially leaving children behind.

Medicaid expansion significantly improves health coverage and access, yet several Southern states face a persistent coverage gap amid political challenges.

The Trump administration recently signed an executive order to address homelessness, sparking concern in some based on the order's wording.

New research highlights which US counties lead in patient experience, health outcomes, and cost efficiency—and the policies that drive success.

Treatment challenges that Anasuya Gunturi, MD, PhD, encounters in her work at Lowell General Hospital include language differences and confusion about scheduled appointments.