Medicare

MA-to-MA switching among dually eligible beneficiaries rose sharply from 2016 to 2022, AJMC study author Grace Mackleby, PhD, found.

CMS finalized the mandatory GLOBE Model, tying Part B drug rebates to international prices in areas covering 25% of beneficiaries from Jan. 1, 2027.

AASM urges CMS to reject proposed 2027 Medicare conversion factor cuts of 1.19% to 1.68% and revise sleep testing and remote monitoring policies.

Sustainable models require asking what a result shows, what design produced it, and whether the design was built to measure value or just produce a number.

Average stand-alone Part D premiums are projected to rise by less than $1 a month as a temporary subsidy program ends after 2026.

Panelists say drug price negotiation, Medicaid changes, prior authorization, and 340B reform strain community oncology.

The NPS index, ranging from –100 to +100, serves as a proxy for customers’ willingness to recommend products and services they themselves have used.

The IRA's Medicare out-of-pocket cap is easing costs for patients with cancer, but community oncology leaders warn price cuts are straining practices.

Biomarker testing, referrals, screening, treatment access, and clinical trial barriers were examined during this recent IVBM.

Measles cases hit a year high. Here's what payers need to know about outbreak costs, MMR coverage, and plans to split the vaccine

Topical ruxolitinib prescribing in Medicare Part D surged through 2024, but its cost per day runs 16 times higher than generic tacrolimus.

Community oncology leaders urge 340B overhaul so drug discounts follow vulnerable cancer patients, with audits, transparency, and tighter contract-pharmacy rules. This commentary will be featured on the Cover of the October issue of Evidence-Based Oncology.

Reference countries have limited room to simply raise their own drug budgets to absorb the pressure, the lead study author explains.

Experts discuss what SCAN Health Plan's new Medicare Advantage (MA) partnership with Costco could mean for beneficiaries, competition, and costs.

CMS is funding 138 grants worth $144M to expand rural mental health, maternal, and emergency care access across Alabama.

Hospice use and higher-intensity care are less common among older adults in isolated rural areas than in urban areas, highlighting rural hospice gaps.

Waist circumference (WC) predicts mortality risk in older adults independent of BMI, with high WC linked to 24% greater death risk, a new study finds.

Taking effect in October 2026, the final rule will end federal Medicaid and CHIP funding for gender-affirming care for transgender minors.

July AJMC author Anuraag R. Kansal, PhD, explains how metastatic cancer diagnoses drive Medicaid spending and why earlier screening could lower costs.

Constrained optimization empirically derived social risk weights that gave equal influence to subgroup performance by dual eligibility and disability in overall contract scores.

This study links county-level social vulnerability to variation in Medicare Advantage prior authorization policies.

A July AJMC study found metastatic cancer diagnoses significantly increase Medicaid spending, highlighting the potential budget benefits of earlier detection.

New cancer drugs reached patients fastest, but overall access timelines remained lengthy across the US, France, Germany, and Switzerland.

CMS value-based payment models underrepresent Black, Hispanic, dual-eligible, and disadvantaged Medicare beneficiaries compared with the broader population.

Dermatologists spend 13 hours weekly on prior authorization as health plans tout an 11% reduction in requests.