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

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Through AHIP, Payers Vow to Rein in Prior Authorization, but Doctors Have Doubts

August 20th 2025

Health insurers commit to reforming prior authorization processes, aiming to enhance patient care and reduce burdens on providers, impacting millions.

PACE participants | Image: National PACE Association
PACE Program Expansion Requires For-Profit Investment, Reduced Regulatory Burden, and Greater Patient Eligibility

August 19th 2025

For Community Oncology, Good News in Physician Fee Schedule Offset by Potential Wreckage of MFP Proposal
For Community Oncology, Good News in Physician Fee Schedule Offset by Potential Wreckage of MFP Proposal

August 1st 2025

PA form | Image: Adobe Stock
KFF Survey: Most Consumers Find Prior Authorization Is a Major Problem

July 25th 2025

Physician burnout | WaveBreakMediaMicro for Adobe
Commentary: Americans Can’t Afford to Lose Access to Their Doctors

July 24th 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

Natalie Dickson, MD
March 6th 2022

Dr Natalie Dickson Discusses 340B Reform From Tennessee Oncology’s Perspective

Hayden E. Klein
Natalie Dickson, MD, president and chief strategy officer of Tennessee Oncology, discusses Tennessee Oncology's role in the discussion to reform 340B.
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March 3rd 2022

What We’re Reading: Medicare Late-Fee Warnings; Pfizer Sends COVID-19 Pills Globally; Judge Blocks Transgender Investigation

AJMC Staff
A bill to provide late-fee warnings to Medicare beneficiaries was introduced; Pfizer is expected to provide 10 million COVID-19 antiviral pills to low- and middle-income nations; a Texas judge halts an investigation into a 16-year-old girl receiving gender-affirming treatment.
pills on scale
February 27th 2022

Metric Aims to Decrease Polypharmacy in Older Adults

Gianna Melillo
A new metric may help improve polypharmacy rates in older adults through identification of low-value prescribing practices.
insurance coverage
February 24th 2022

End of Public Health Emergency Triggers End to Medicare, Medicaid Flexibilities

Laura Joszt, MA
During an AHIP webinar, Mark Hamelburg, senior vice president of federal programs at AHIP, explained the shifts coming to Medicare and Medicaid when the public health emergency finally ends.
CMS Redesigns Direct Contracting Into an Equity-Focused ACO Model
February 24th 2022

CMS Redesigns Direct Contracting Into an Equity-Focused ACO Model

Allison Inserro
The redesigned accountable care organization (ACO) model is called the Realizing Equity, Access, and Community Health model and is scheduled to begin in 2023.
Stephen Schleicher, MD, MBA
February 20th 2022

Dr Stephen Schleicher on Tennessee Oncology's Plans Post OCM

Hayden E. Klein
Stephen Schleicher, MD, MBA, chief medical officer of Tennessee Oncology, discusses the practice's plans to continue providing quality oncology care to its patients after the end of the Oncology Care Model (OCM).
What We're Reading
February 16th 2022

What We’re Reading: Woman Cured of HIV; COVID-19 Vaccination During Pregnancy; Fight to Continue Direct Contracting Model

AJMC Staff
A woman is now the third person in the world to be cured of HIV; CDC data suggest vaccinating women against COVID-19 during pregnancy may protect infants after birth; provider groups push to keep Direct Contracting payment model.
Karen Kobelski, MBA.
February 15th 2022

Contributor: 3 Ways Health Plans Can Ensure Risk Adjustment Compliance

Karen Kobelski, MBA
By making diligent compliance efforts a priority in the years ahead, health plans can shore up existing processes to achieve financial success and ensure risk adjustment as regulatory bodies take aim at organizational missteps.
What we're reading.
February 14th 2022

What We're Reading: COVID-19 Vaccine Expansion Halted; PBM Probe; High-Volume Antibiotic Prescribers

AJMC Staff
The FDA delays its decision on Pfizer/BioNTech’s COVID-19 vaccine in young children; the Federal Trade Commission (FTC) will vote on whether to investigate pharmacy benefit managers (PBMs); nearly half of high-volume antibiotic prescribers are located in Southern states.
Alternative Payment Models Can Stabilize and Improve Practice Radiation Reimbursement
February 14th 2022

Alternative Payment Models Can Stabilize and Improve Practice Radiation Reimbursement

Courtney Dean, MBA
How Value-based Care Is Changing Radiation Oncology for the Better
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February 14th 2022

From Our Partners: Schleicher, Dickson Take New Roles at Tennessee Oncology

Hayden E. Klein Mary Caffrey
The changes come as Tennessee Oncology must now plan for a gap between the Oncology Care Model and a future alternative payment model from CMS.
Natalie Dickson, MD
February 13th 2022

Dr Natalie Dickson Discusses Challenges for Tennessee Oncology, Community Oncology

Hayden E. Klein
Natalie Dickson, MD, president and chief strategy officer of Tennessee Oncology, discusses challenges for Tennessee Oncology and community oncology in general.
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February 7th 2022

Effects of an Out-of-Pocket Maximum in Medicare Part D

Sonal Parasrampuria, PhD, MPH Gerard F. Anderson, PhD
This study compares the impact of the 3 different out-of-pocket maximums proposed in Congress and by the Medicare Payment Advisory Commission.
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February 4th 2022

Association of Opioid Utilization Management With Prescribing and Overdose

Martin S. Andersen, PhD Vincent Lorenz, MA Anurag Pant, MA Jeremy W. Bray, PhD G. Caleb Alexander, MD, MS
Opioid utilization management in Medicare was associated with mixed effects on opioid prescribing, and prior authorization was associated with a decreased likelihood of subsequent overdose.
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February 4th 2022

Value-Based Care Through Postacute Home Health Under CMS PACT Regulations

Patrick Racsa, MS Teresa Rogstad, MPH Brent Stice, MBA Matthew Flagg, MBA Chase Dailey, MBA Yong Li, PhD Brittany Sallee, BS Karen Worley, PhD Anup Sharma, MD David Annand, MD
Among a patient population defined by CMS postacute care transfer regulations, home health vs no postacute care was associated with reduced 30-day readmissions and costs.
hand holding prescription bottle
February 3rd 2022

Behavioral Therapy Can Help Reduce Polypharmacy in Borderline Personality Disorder, Study Finds

Gianna Melillo
Results of a retrospective study conducted in Spain found that dialectical-behavioral therapy skills training can help mitigate polypharmacy in those with borderline personality disorder.
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February 3rd 2022

What We’re Reading: Boosters Slash COVID-19 Deaths; Generic Restasis Cleared; Medicare Advantage and Health Equity

AJMC Staff
Americans who are boosted are 95 times less likely than unvaccinated people to die of COVID-19, the FDA approved the first generic drug for Restasis to treat dry eye syndrome, and CMS is putting a greater focus on health equity for Medicare Advantage and Part D plans.
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February 2nd 2022

Inability to Access Health Care Due to COVID-19 Among Medicare Beneficiaries

Chanhyun Park, PhD Boon Peng Ng, PhD Kiyoung Kim, PhD
Up to one-fifth of Medicare beneficiaries were unable to access health care due to the COVID-19 pandemic in 2020.
Geoffrey Boyce
January 31st 2022

Array CEO Geoffrey Boyce Discusses AtHome Telebehavioral Health Services

Hayden E. Klein
Geoffrey Boyce, CEO of Array Behavioral Care, discusses Array AtHome’s telebehavioral health services, which are now available to approximately 5 million Humana Medicare Advantage members.
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January 27th 2022

What We’re Reading: Omicron-Specific Vaccine Trials; Health Insurance Enrollment Gains; Public Nursing Home Staffing Data

AJMC Staff
Pfizer and Moderna announced commencement of trials for Omicron-specific booster shots; 14.5 million Americans gained health coverage since November 2021; Medicare’s website for consumers to research nursing home staffing is up and running.
pen and calculator
January 26th 2022

Number of Accountable Care Organizations Joining MSSP in 2022 Grew Slightly, CMS Says

Allison Inserro
In its annual Medicare Shared Savings Program (MSSP) report, CMS said the number of accountable care organizations joining increased, but a trade group said the results should have been better.
pills
January 24th 2022

Study Finds High Polypharmacy Rates Among Those With History of Depression

Gianna Melillo
Results of a study carried out in Iran found those with a recent history of depressive disorders were more likely to suffer from polypharmacy, or taking 5 or more medications concurrently.
What We're Reading
January 21st 2022

What We’re Reading: Unvaccinated Seniors at Higher Risk for Hospitalization, Nursing Homes in Crisis; Alzheimer Groups Protest

AJMC Staff
Unvaccinated older adults are 49 times more likely to be hospitalized after contracting COVID-19; nursing homes are experiencing a major staffing crisis; major Alzheimer groups plan to meet with federal officials and lawmakers to protest the CMS drug proposal.
Pills being weighed
January 19th 2022

Polypharmacy Linked With Rehospitalization, Death Among Patients With HF

Gianna Melillo
An analysis conducted in Japan among patients with acute decompensated heart failure (HF) revealed excessive polypharmacy at hospital discharge is associated with an increased risk of mortality after 1 year.
Jason Z. Rose, MHSA
January 16th 2022

Contributor: Technology-Based Telepharmacy Needed to Engage High-risk Patients, Improve Medication Adherence

Jason Z. Rose, MHSA
Medicare Advantage plans must leverage data-driven insights and omnichannel telepharmacy software to guide meaningful interactions with high-risk members and boost Star Ratings performance.
pill graphic
January 14th 2022

Medicine Review Reduces Polypharmacy in Older Adults

Allison Inserro
The randomized study consisted of an intervention delivered by general practitioners in the Republic of Ireland.
Graphic illustrating healthcare costs
January 11th 2022

CMS Says It Will Limit Biogen’s AD Drug to Patients in Clinical Trials

Allison Inserro
In a National Coverage Determination decision memo released Tuesday, CMS said it will gather public comment for 30 days about its plan to limit coverage for Alzheimer disease (AD) biologics that target plaque buildup in the brain to patients enrolled in certain clinical trials.
Image of conversation between physician and older patient
January 8th 2022

Increased Patient-Physician Dialogue in EDs May Reduce Polypharmacy in Older Patients

Rose McNulty
A Danish study observed emergency department (ED) health care providers and identified 5 factors that could play into patient involvement in medication discussions, particularly in older patients with polypharmacy.
graphic representing cost of health care
January 7th 2022

CMS Seeks to Pass Part D Price Reductions to Beneficiaries

Allison Inserro
CMS proposed rulemaking Thursday that would pass pharmaceutical price concessions to beneficiaries in Medicare Part D plans and make the medical loss ratio in Medicare Advantage plans more robust.
Most-Read AJAC Papers of 2021
December 27th 2021

Most-Read AJAC Papers of 2021

Laura Joszt, MA
The most-read AJAC papers of 2021 analyze real-world programs to transform health care and provide insight into physician perspectives of health care and insurance.
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