Medicare

The AJMC® Medicare compendium is a comprehensive resource for clinical news and expert insights on issues that affect Medicare beneficiaries with a focus on polypharmacy, reimbursement challenges, and other topics related to seniors.

Latest News

glp-1 Wegovy, semaglutide | Image credit: Patrick Bay Damsted - stock.adobe.com
Can Medicare Sustain Widespread Access to GLP-1 Therapies?

April 25th 2025

Expanding Medicare coverage for glucagon-like peptide 1 (GLP-1) receptor agonists could significantly reduce obesity-related health issues, but it also risks adding tens of billions in new costs, highlighting the need for smart policy strategies to ensure access, affordability, and long-term sustainability.

AJMC
Impact of Hospital-Physician Integration on Medicare Patient Mix

April 11th 2025

CMS. | Image Credit: Postmodern Studio - stock.adobe.com
Survey Finds Slow Start on CMS Interoperability Rule Implementation

April 10th 2025

AJMC
Comparing Breast Cancer Treatment Outcomes Between Fee-for-Service and Medicare Advantage

April 4th 2025

inflation reduction act | Image credit: Vitalii Vodolazskyi -stock.adobe.com
The IRA’s Unintended Consequences for Drug Pricing and Coverage

April 2nd 2025

Examining the Benefit of an Innovative Enhanced Medication Therapy Management Model

In this series of articles, the authors present the MedWise Risk Score, an enhanced medication therapy management model, and its impact on medication safety reviews and health care outcomes.

AJMC Supplement Cover for Examining the Benefit of an Innovative Enhanced Medication Therapy Management Model

More News

Center on Health Equity and Access
September 7th 2024

Health Equity & Access Weekly Roundup: September 7, 2024

Giuliana Grossi
The Center on Health Equity & Access provides the latest news, research, and expert opinions on the state of equity in health care.
Semaglutide Ozempic injection blood sugar obesity - myskin - stock.adobe.com.jpeg
August 26th 2024

Medicare Semaglutide Coverage: Millions May Gain Access That Could Cost $145 Billion

Giuliana Grossi
Medicare has not clearly defined what constitutes "established cardiovascular disease," leading to variability in potential patient eligibility; therefore, researchers aimed to estimate the number of Medicare beneficiaries who would become newly eligible for semaglutide under different definitions.
COA seal | Image : COA
August 16th 2024

Revised EOM Offers More Favorable Opportunities for Community Practices, Experts Say

Mary Caffrey
Prescription drugs on a money banknotes. Concept of healthcare costs - Vitalii - stock.adobe.com
August 5th 2024

Survey Exposes Pervasive Billing Errors, Aggressive Tactics in US Health Insurance

Giuliana Grossi
Almost half of insured Americans report receiving unexpected medical bills, leading to financial strain and contributing to worsening health outcomes for many patients, The Commonwealth Fund report reveals.
Stethoscope and US dollar banknotes on chart or graph paper, Financial, account, statistics and business data medical health concept - amazing studio - stock.adobe.com
July 11th 2024

CMS Unveils Proposed 2025 Physician Fee Schedule, Maternal Health Standards

Giuliana Grossi
The 2025 Physician Fee Schedule includes a conversion factor reduction, expanded behavioral health services, extended telehealth waivers, new Quality Payment Program pathways, and measures to address suspect billing, alongside a Biden administration initiative introducing federal maternal health standards for hospitals.
Stack of wood blocks with insurance and health care icons | Image credit: A stockphoto - stock.adobe.com
June 24th 2024

Medicare Advantage Plans Provide No Substantial Cost Savings Over Traditional Medicare

Laura Joszt, MA
Beneficiaries who switched from traditional Medicare to a Medicare Advantage plan experienced no additional protection from medical costs compared with those who stayed in a traditional Medicare plan.
Center on Health Equity & Access
June 15th 2024

Health Equity & Access Weekly Roundup: June 15, 2024

Giuliana Grossi
The Center on Health Equity & Access shares the latest news, research, and expert insights on developments related to health disparities, gaps in care, and initiatives to address them.
double exposure background of health insurance card - Mongkolchon - stock.adobe.com
June 12th 2024

US Health Spending Hits $4.8 Trillion, Insurance Coverage Peaks in 2023 Projections

Giuliana Grossi
New estimations show a historic increase in health spending last year, which is projected to account for 19.7% of the gross domestic product by 2032.
Health equity | Image Credit: Tarik Vision - stock.adobe.com
June 12th 2024

CMS Innovation Center's Latest Moves: Embedding Equity Into Value-Based Care

Giuliana Grossi
During the CMS Health Equity Conference, health care leaders shared groundbreaking strategies to integrate health equity into value-based care models, aiming to enhance patient outcomes and reduce costs.
Stethoscope on money | Image credit: utah51 - stock.adobe.com
May 6th 2024

Medicare Trust Fund Extends Solvency Another 5 Years

Laura Joszt, MA
The Medicare trust fund is now expected to deplete in 2036, with the Inflation Reduction Act being credited for at least some of the extension.
Medicare and Medicaid stamps | Image credit: Olivier Le Moal – stock.adobe.com
April 30th 2024

Medicaid, Medicare Policy Changes Could Lead to More Than 25,000 Additional Deaths, Study Says

Hayden E. Klein
Researchers also estimated that more than 700,000 Americans with diabetes could lose insurance coverage if these proposed retractions are put into place, with some new policies already in effect.
AJMC
April 8th 2024

High-Need Beneficiary Enrollment Patterns in Medicare Advantage and Traditional Medicare

Aig Unuigbe, PhD Inna Cintina, PhD Julia Sheriff, MAS Lane Koenig, PhD
Accounting for 32% of all Medicare enrollees in 2019, high-need beneficiaries were more likely to be in traditional Medicare than Medicare Advantage.
Technology Helps Community Oncology Practices Implement PCM, CCM
February 14th 2024

Technology Helps Community Oncology Practices Implement PCM, CCM

Cameron Santoro
Pills on top of money | image credit: Cagkan - stock.adobe.com
January 9th 2024

Americans Often Pay 3 Times More for Medicare Drugs Up for Negotiation Than Comparable Countries

Laura Joszt, MA
Based on a comparison of prices for drugs up for Medicare price negotiations, there is a long way to go to reach the prices of 7 comparable countries.
Gavel and Stethoscope | Image credit: Andy Dean - stock.adobe.com
October 5th 2023

Alleged Medicare Fraud: Fresenius Vascular Care Faces Civil Lawsuit for Unnecessary Surgeries

Giuliana Grossi
Fresenius Vascular Care's own research reportedly showed these surgeries not only failed to benefit patients with end-stage renal disease, but also potentially damaged their ability to receive essential dialysis treatment.
Site Logo
April 25th 2023

Understanding Factors Associated With Increases in Medicare Advantage Enrollment, 2007-2018

Adam Atherly, PhD Roger Feldman, PhD Eline M. van den Broek-Altenburg, PhD Bryan Dowd, PhD
Increases in Medicare Advantage market share over the past 10 years are largely caused by an increased preference for managed care among Medicare beneficiaries.
Site Logo
April 4th 2023

Part D Beneficiaries’ Incentives and Responses Under Preferred Pharmacy Networks

Jianhui Xu, PhD Erin Trish, PhD Geoffrey Joyce, PhD
Under preferred pharmacy networks, unsubsidized Part D beneficiaries faced substantial incentives and moderately switched toward preferred pharmacies, whereas subsidized beneficiaries were insulated and demonstrated little switching.
AJAC logo
March 15th 2023

Eliminating Defects in Value: Turnaround of an MSSP ACO

Peter J. Pronovost, MD, PhD Patrick Runnels, MD, MBA Mark E. Schario, MS, RN Tomasina Green, MPH Kelsey A. Fuller, MS Heather M. Byrne, MPA-HSA, CNMT Valerie Reese, MEd Tyler D. Barnett, MHSA Kaitlin Mabin, BA George Topalsky, MD
A health system transformational leadership framework and management system made visible and eliminated defects in value and was associated with reduced annual Medicare expenditures and increased quality between 2017 and 2020.
Site Logo
March 9th 2023

Development of a Medicare Plan Dashboard to Promote Health Equity

Steven C. Martino, PhD Megan Mathews, MS Megan K. Beckett, PhD Denis Agniel, PhD Katrin Hambarsoomian, MS Sarah Hudson Scholle, DrPH Sierra Collins, MHA Denise D. Quigley, PhD Biayna Darabidian, BA Marc N. Elliott, PhD
Health plans use data to decide on quality improvement initiatives. Having a dashboard that characterizes how equitably plans are serving their enrollees would promote health equity.
humana logo
February 23rd 2023

Humana Leaving Commercial Business, Will Focus on Government-Funded Programs

Laura Joszt, MA
Over the next 18 to 24 months, Humana is exiting the commercial health plan business to focus on government-funded programs, like Medicare Advantage, and specialty businesses.
Evidence-Based Oncology logo
December 2nd 2022

Breaking New Ground in Episodes of Care, Including CAR T-Cell Therapy

Mary Caffrey
Coverage from the Institute for Value-Based Medicine® session with Astera Cancer Care in Edison, New Jersey, held November 3, 2022.
Patient in hospital.
October 25th 2022

Updated Clinical Practice Guidelines for CDI Show Improved Outcomes, but Adherence Issues Remain

Matthew Gavidia
Improved outcomes associated with fidaxomicin compared with vancomycin suggest benefits from its greater use in Medicare patients, although uptake remains low despite its recommended use.
Population health.
September 30th 2022

Panel Reviews Health Inequities and Opportunities for Innovation Through Population Health Delivery

Matthew Gavidia
A panel discussion at the 70th Annual Roy A. Bowers Pharmaceutical Conference addressed recent care delivery initiatives in New Jersey that aim to address health inequities and other population health concerns.
New Enhancing Oncology Model Builds on Knowledge From the OCM
August 15th 2022

New Enhancing Oncology Model Builds on Knowledge From the OCM

Stuart Staggs, MSIE
OCM Successor Puts Focus on Equity in Cancer Care—With Fewer Dollars for Services
August 15th 2022

OCM Successor Puts Focus on Equity in Cancer Care—With Fewer Dollars for Services

Mary Caffrey
Contributor: How Medication Risk Scores Improve Health for Medicare Beneficiaries
July 27th 2022

Contributor: How Medication Risk Scores Improve Health for Medicare Beneficiaries

Michael S. Awadalla
Medication risk scores analyze an individual’s medication regimen to look for the potential for simultaneous, multi-drug interactions, which can cause adverse drug events and other medication-related harms.
Yoona Kim, Pharm D, PhD, CEO, Arine
July 18th 2022

Contributor: The Need to Go Beyond Medication Adherence in the Medicare Population

Yoona Kim, PharmD, PhD
Medication adherence is not the only area to focus on for older adults who have Medicare coverage. Optimizing treatment and medication access are also important.
Site Logo
July 13th 2022

Geographic Variation in Medicare Home Health Expenditures

Robert F. Schuldt, PhD Amy L. M. Lallier, MPH Hsueh-Fen Chen, PhD J. Mick Tilford, PhD
This study attempts to identify the sources of the significant 2.5-fold variation found in home health expenditures, a possible indicator of inefficiency and waste.
Site Logo
July 12th 2022

Medicare Advantage Coverage Restrictions for the Costliest Physician-Administered Drugs

Kelly E. Anderson, PhD, MPP G. Caleb Alexander, MD, MS Carolyne Ma, PharmD Sydney M. Dy, MD Aditi P. Sen, PhD, MA
Four large Medicare Advantage insurers manage access to expensive physician-administered drugs with a combination of prior authorization, step therapy, and Part D formulary design.
Robert Pittman, SVP, Government Affairs, Modivcare
July 10th 2022

Contributor: Technology, Supplemental Services in MA Can Help Improve Participant Health

Robert Pittman
Social determinants of health present many health-related challenges for Medicare Advantage (MA) plan members, something these plans are looking to overcome by diversifying their service offerings.
<12345678>

2 Commerce Drive
Suite 100
Cranbury, NJ 08512

© 2025 MJH Life Sciences® and AJMC®.
All rights reserved.

About
Contact
Editorial Boards
Advertise
Do Not Sell My Information
Terms & Conditions
Privacy Policy
AJMC Managed Markets Network Logo
CH LogoCenter for Biosimilars Logo