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What We're Reading: HealthCare.gov Maintenance; USMCA Drug Exclusivity; Medicare Telemedicine Proposal
When consumers try to sign up for Affordable Care Act health plans on the federal marketplace, they may encounter hours-long downtime for the site; the United States–Mexico–Canada Agreement would increase pharmaceutical exclusivity from 8 years to 10 years, delay access to competition from biosimilar biologics; Medicare is considering paying for telemedicine for a 5-minute check-in call, but physicians question the proposal.
Administration Plans HealthCare.gov Maintenance During Open Enrollment
When consumers try to sign up for Affordable Care Act health plans on the federal marketplace, they may encounter hours-long downtime for the site. According to The Hill, the Trump administration is planning to take the site down for maintenance from 12 am to 12 pm each Sunday, except for the last Sunday, during the sign-up period. The maintenance schedule is the same as last year’s, which had drawn criticism from advocates who said the planned maintenance during open enrollment would hinder efforts to sign people up for coverage.
NAFTA Replacement Could Thwart Biosimilars
The United States—Mexico–Canada Agreement, or USMCA, updates the North American Free Trade Agreement and increase pharmaceutical exclusivity from 8 years to 10 years. The new deal allows US drug companies to sell pharmaceutical products in Canada for 10 years without generic or biosimilar competition, according to The Center for Biosimilars®, a sister site of The American Journal of Managed Care®. The concern is that USMCA will delay access to competition from biosimilar biologics, which can increase costs for patients and payers, but benefit the pharmaceutical industry. The Pharmaceutical Research and Manufacturers of America (PhRMA) supported the agreement and the intellectual property protections, which PhRMA President and CEO Stephen J. Ubl called the “lifeblood” of the biopharmaceutical industry.
Physicians Question Medicare’s Proposed Telemedicine Reimbursement
Medicare is considering paying for telemedicine by reimbursing doctors $14 for a 5-minute check-in call with patients. However, many physicians are unhappy that patients would be required to pay a 20% cost-sharing charge. Kaiser Health News reported that many physicians who provide telemedicine services do so for free. Less than 1% of Medicare beneficiaries use telemedicine services annually. Under the Medicare reimbursement the call would be used to determine if patients need to come in for an appointment, but virtual sessions can cover an array of services including monitoring patients on a new medicine or helping patients to manage a chronic disease.
Laundromats as a New Frontier in Community Health, Medicaid Outreach
May 29th 2025Lindsey Leininger, PhD, and Allister Chang, MPA, highlight the potential of laundromats as accessible, community-based settings to support Medicaid outreach, foster trust, and connect families with essential health and social services.
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Managed Care Reflections: A Q&A With Melinda B. Buntin, PhD
June 2nd 2025To 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 June issue features a conversation with Melinda B. Buntin, PhD, a health economist and a Bloomberg Distinguished Professor at the Johns Hopkins Bloomberg School of Public Health and Carey Business School.
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Inside the Center's MDD Value Model and Its Use of Dynamic Pricing
May 13th 2025Larragem Raines, MS, of the Center for Innovation & Value Research, discusses the organization's major depressive disorder (MDD) open-source value model, dynamic pricing, and the future role of artificial intelligence in care.
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