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.

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Health Policy in Flux: Trump Administration Updates

May 20th 2025

HHS announces it is taking steps to implement President Trump’s Executive Order on prescription drug pricing. Keep up with the latest moves made in health policy under President Donald Trump's second administration. This timeline will be updated as orders and policy progress.

AJMC
Health Outcomes Under Full-Risk Medicare Advantage vs Traditional Medicare

May 9th 2025

AJMC
Evaluating Access to Care for Medicare Beneficiaries Younger Than 65 Years

May 7th 2025

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Can Medicare Sustain Widespread Access to GLP-1 Therapies?

April 25th 2025

AJMC
Impact of Hospital-Physician Integration on Medicare Patient Mix

April 11th 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

Highest Cancer Care Cost Burden Happens at 2 Time Points in Medicare, Report Says
October 29th 2021

Highest Cancer Care Cost Burden Happens at 2 Time Points in Medicare, Report Says

Allison Inserro
The annual report, from the American Cancer Society, National Cancer Institute, the CDC, and the North American Association of Central Cancer Registries, details US cancer trends.
CMS Announces "Refresh" of CMMI With Focus on Health Equity, Fewer Models
October 20th 2021

CMS Announces "Refresh" of CMMI With Focus on Health Equity, Fewer Models

Gianna Melillo Mary Caffrey
Physician and health policy advocates praised the emphasis on streamlining models and ending silos, but practices that invested in the Oncology Care Model (OCM) await key details.
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October 18th 2021

Comparison of the Use of Top-Ranked Cancer Hospitals Between Medicare Advantage and Traditional Medicare

Daeho Kim, PhD David J. Meyers, PhD, MPH Momotazur Rahman, PhD Amal N. Trivedi, MD, MPH
Medicare Advantage enrollees, particularly those with lower out-of-network benefits, may have restricted access to top-ranked hospitals for complex cancer care compared with traditional Medicare enrollees.
Most MA Plans in Annual CMS Report See Star Ratings Increase
October 8th 2021

Most MA Plans in Annual CMS Report See Star Ratings Increase

Allison Inserro
Ahead of Medicare open enrollment, which starts October 15, CMS released its annual report of which Medicare Advantage (MA) and Part D drug plans achieved 5-star ratings.
Jason Z. Rose, MHSA
October 4th 2021

Contributor: Why Medicare Advantage Plans Must Transform Post Discharge to Medication-Focused Transitions of Care

Jason Z. Rose, MHSA
The 2022 performance year’s Star Ratings require Medicare Advantage plans to take a more significant role in preventing readmissions.
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October 2nd 2021

ADA vs CBO: Including Dental Coverage Under Medicare

Hayden E. Klein
The Congressional Budget Office (CBO) estimated that adding dental, vision, and hearing benefits would increase Medicare’s direct spending, but the American Dental Association (ADA) is claiming reimbursement will not be enough to cover these costs
HHS Investigation Finds Medicare Insurers Drew $9.2 Billion Through Controversial Billing Practices
September 29th 2021

HHS Investigation Finds Medicare Insurers Drew $9.2 Billion Through Controversial Billing Practices

Hayden E. Klein
One company received approximately $3.7 billion while enrolling only 22% of Medicare Advantage customers.
Study Contradicts Other Research About Potentially Inappropriate Medications Among Older Adults
September 22nd 2021

Study Contradicts Other Research About Potentially Inappropriate Medications Among Older Adults

Jaime Rosenberg
The current study found that those prescribed potentially inappropriate medications were actually less likely to revisit the emergency department within 30 days, in contrast to prior work.
BPCI Model Not Equipped to Tackle Reform of SNF Spending, Researchers Find
September 17th 2021

BPCI Model Not Equipped to Tackle Reform of SNF Spending, Researchers Find

Hayden E. Klein
The study found that BPCI Model 3, which held postacute facilities accountable for costs of care, was not associated with payment reductions or changes in other quality and selection metrics among skilled nursing facilities.
Picture of the White House
September 9th 2021

Biden Administration Drug Plan Includes Value-Based Payment Ideas for Medicare

Allison Inserro
The administration said it would make the results of its drug price negotiations with manufacturers, as well as its approach to value-based care models, open to a variety of payers.
Scott Palmer, MBA
September 6th 2021

Consumer Data Transparency Is More Important Than Ever as the Battle Against COVID Rages On

Scott Palmer, MBA
On January 1, CMS implemented the Hospital Price Transparency final rule, but by July, it was clear that many hospitals were noncompliant. Even with a proposed rule for penalties, requirements still only fall on certain parts of the health care industry.
Potentially Inappropriate Medication Use Highly Prevalent in Older Adults
September 3rd 2021

Potentially Inappropriate Medication Use Highly Prevalent in Older Adults

Hayden E. Klein
Polypharmacy may be raising the risk of inappropriate medication use, and avoiding this is crucial.
Older woman sitting on couch
August 28th 2021

Are PIMs Linked to Frailty in Older Adults?

Allison Inserro
The use of potentially inappropriate medications (PIMs) by older adults appeared to be linked to a greater risk of frailty, although the researchers said further work is needed.
older man
August 26th 2021

Addressing Polypharmacy, PIMs in Geriatric Patients With Cancer

Gianna Melillo
Researchers offer recommendations for addressing polypharmacy and potentially inappropriate medication (PIM) use among older patients with cancer.
Erin Crum, MPH
August 17th 2021

Clinicians and Payers Expect to Wait and See Before Embracing CMS’ MIPS Value Pathways

Erin Crum, MPH
DOI: 10.37765/ajmc.2021.88735
J. Thomas “Tommy” May
August 16th 2021

Contributor: Medicare Needs to Ensure People With ALS Have Access to Clinically Appropriate Respiratory Care

J. Thomas May
The pandemic has shown a spotlight on how critically important respiratory care is to Americans who struggle to breathe on their own. Yet, Medicare policy must be updated to ensure that access to lifesaving equipment will never be disrupted.
IQVIA
August 16th 2021

ASCO 2021 Recap: Health-Related Quality of Life

Mary Caffrey Matthew Gavidia
Review Describes Evidence Regarding Deprescribing Interventions for Older Patients
August 14th 2021

Review Describes Evidence Regarding Deprescribing Interventions for Older Patients

Lauren Massaro
Updated evidence provides new insight into safety, efficacy, and challenges of deprescribing.
man holding a smartphone
August 13th 2021

Smartphone App Improves Medication Adherence for Patients Needing Polypharmacy

Skylar Jeremias
Use of a smartphone-based application was found to improve medication adherence and some clinical outcomes in patients managing multiple comorbidities using polypharmacy, researchers concluded.
What We’re Reading: 2.5 Million Americans Enroll in Health Care Coverage; Telemedicine Company Owner Charged With Fraud; Hospital Staff Shortages Due to COVID-19
August 11th 2021

What We’re Reading: 2.5 Million Americans Enroll in Health Care Coverage; Telemedicine Company Owner Charged With Fraud; Hospital Staff Shortages Due to COVID-19

AJMC Staff
Late July brings a 64% enrollment increase; owner charged with fraudulently billing Medicare over $784 million; COVID-19 hot spots lose nurses due to burnout.
Links Between Polypharmacy, Clinical Frailty Seen in UK Critical Care Admissions
August 3rd 2021

Links Between Polypharmacy, Clinical Frailty Seen in UK Critical Care Admissions

Hayden E. Klein
Identifying patients with combined polypharmacy and frailty can help recognize ICU patients with high risk of hospital readmission, the authors said.
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August 3rd 2021

What We’re Reading: 70% of US Vaccinated; CMS Payment Rules Released; Alcohol Consumption and Cancer

AJMC Staff
Seventy percent of Americans have received at least 1 dose of a COVID-19 vaccine; CMS releases payment rules for fiscal year 2022; alcohol linked to over 700,000 new cancer diagnoses in 2020.
Picture of pharmacist with older patient
August 2nd 2021

Study Highlights Use of PIMs in US Adults With Multimorbidity, Polypharmacy

Allison Inserro
The study was conducted to shed more light on the growing issue of polypharmacy, an issue that is expected to increase as the US population ages.
Older man holding pill
July 31st 2021

Reducing Number of Drugs in Older Adults Shows Benefit 6 Months Later

Allison Inserro
Drug optimization in older adults improved outcomes in this retrospective study.
Most Older Patients Can Manage Drugs After Hospital Discharge, Study Finds
July 29th 2021

Most Older Patients Can Manage Drugs After Hospital Discharge, Study Finds

Hayden E. Klein
However, letting nurses have total control of medication management during hospital stays can create problems afterward.
Many pills
July 24th 2021

Polypharmacy Linked to Higher Risk of Hospital Readmission

Allison Inserro
While polypharmacy, along with hospital length of stay and other factors, was linked to a higher risk of 30-day hospital readmission, the type of medication mattered as well.
Medicare Patients Eligible for Medication Therapy Management More Sensitive to Cost-Related Adherence
July 21st 2021

Medicare Patients Eligible for Medication Therapy Management More Sensitive to Cost-Related Adherence

Hayden E. Klein
Future Medicare Part D models should consider alternative strategies to improve cost-related non-adherence.
Picture of patient during telemedicine visit
July 16th 2021

MA Primary Care Payment Models Influenced Telemedicine Usage During the Pandemic, Research Shows

Allison Inserro
Larger primary care practices in downside risk–only payment models and capitation saw the highest telemedicine utilization rates by their patients enrolled in Medicare Advantage (MA) plans.
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July 15th 2021

Trends in Medicare Part D Coverage of Generics With Equivalent Brand-Name Drugs

Stacie B. Dusetzina, PhD Juliette Cubanski, PhD Andrew W. Roberts, PharmD, PhD Jack Hoadley, PhD Sarah True, MPH, MSW Leonce Nshuti, MSc Tricia Neuman, ScD
High-tier generic drug placement in Medicare Part D has increased over time, but it may be related to a drug’s clinical profile and availability of substitutes rather than preferred brand-name drug coverage.
FDA logo
July 14th 2021

How Biogen’s Aduhelm Approval Marks a Precipitous Turning Point for the FDA

Gianna Melillo
A string of controversies surrounding the approval of Biogen's Alzheimer disease drug aducanumab (Aduhelm) has not only called into question the independent nature of the FDA, but puts both providers and patients in a challenging position when it comes to deciding whether or not to prescribe or take the treatment.
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