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

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

July 25th 2025

A new survey reveals widespread consumer frustration with prior authorization, highlighting the need for urgent reform in insurance coverage.

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

July 24th 2025

Dermatologist medicine. | Image Credit: LIGHTFIELD STUDIOS - stock.adobe.com
Specialty Drug Costs Drive Medicare Part D Dermatology Expenditures

July 22nd 2025

Diverse docs leaving Medicare | Image Credit Maggie-sora.chatgpt.com
Primary Care Doctors Lead Rising Physician Exodus From Medicare

July 21st 2025

CMS Adminstrator Mehmet Oz, MD, MBA, speaks with AtlantiCare CEO Michael Charlton, MHL, during a visit to Atlantic City.
As CMS Embarks on “Rural Transformation,” a New Jersey Health System Weighs In

July 19th 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

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.
newspaper stack
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.
Site Logo
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.
Site Logo
July 12th 2021

Care for Food-Insecure Enrollees in Medicare Advantage vs Traditional Medicare

Sungchul Park, PhD Brent A. Langellier, PhD
Medicare Advantage plans may deliver care more efficiently to food-insecure beneficiaries than traditional Medicare, but they are not better at reducing food insecurity.
Costco Prescription Distribution System Could Have Saved Medicare $2.6 Billion, Study Finds
July 9th 2021

Costco Prescription Distribution System Could Have Saved Medicare $2.6 Billion, Study Finds

Hayden E. Klein
PBMs keep copays higher on the same generic drugs.
Contributor: MACRA Has Not Lived Up to Its Promise
July 5th 2021

Contributor: MACRA Has Not Lived Up to Its Promise

Travis Broome, MPH, MBA
The Medicare Access and CHIP Reauthorization Act (MACRA) needs to be reimagined get back on track and to live up to its promise to incentivize value-based care.
ASCO Studies Cover Healthcare Utilization, Quality of Life Data
July 4th 2021

ASCO Studies Cover Healthcare Utilization, Quality of Life Data

Mary Caffrey
Abstracts cover the cost of cancer-related diarrhea, 30-day readmission rates, and how perceptions of the likelihood of survival affect end-of-life care.
Medication Management Led to Improvements in Older Adults With CKD, Study Shows
July 2nd 2021

Medication Management Led to Improvements in Older Adults With CKD, Study Shows

Lauren Massaro
A pharmacist-led collaborative medication management service reduced problems associated with polypharmacy in older adults with chronic kidney disease (CKD).
Senator, Health Care Executives Discuss What’s Next in Payment, Access Issues
June 24th 2021

Senator, Health Care Executives Discuss What’s Next in Payment, Access Issues

Allison Inserro
The head of AHIP sat down with a senator and 3 health care executives for a conversation about payment and access issues at the organization's 2021 Institute and Expo Online.
Observations Regarding the Average Sales Price Reimbursement Methodology
June 21st 2021

Observations Regarding the Average Sales Price Reimbursement Methodology

Susan Weidner, MBA, MS Michael Diaz, MD Cass Schaedig Lucio Gordan, MD
MedPAC to Congress: Change MA Benchmarks, Slow Down on APMs
June 18th 2021

MedPAC to Congress: Change MA Benchmarks, Slow Down on APMs

Lauren Massaro Allison Inserro
The Medicare Payment Advisory Commission (MedPAC) suggested several changes to Medicare Advantage (MA) plan benchmark calculations, with the intent to generate yield savings for Medicare, and urged CMS to streamline alternative payment model (APMs) where it can.
Supreme Court
June 17th 2021

Supreme Court Tosses Challenge to ACA for Lack of Standing

Allison Inserro Christina Mattina
In a 7 to 2 decision, the Supreme Court ruled Thursday that the Affordable Care Act (ACA) will stand, as plaintiffs seeking to declare the law unconstitutional did not have standing.
Softer Alignment of Medicare ACOs May Still Lead to Higher Prices for Office Visits
June 7th 2021

Softer Alignment of Medicare ACOs May Still Lead to Higher Prices for Office Visits

Allison Inserro
The researchers created a model that simulated what would happen when health systems and providers began working together in Medicare accountable care organizations (ACOs) in arrangements that did not extend to outright mergers or acquisitions.
Davey Daniel, MD, Hematology and Medical Oncology Specialist, Tennessee Oncology.
June 4th 2021

Dr Davey Daniel on Lower Cost of Care Seen in Clinical Trials for OCM Enrollees

Davey Daniel, MD, hematology/medical oncology specialist, Tennessee Oncology, discusses findings of an abstract presented at ASCO 2021 showing a lower total cost of care paid by Medicare for episodes of care for patients in the Oncology Care Model (OCM) enrolled in clinical trials vs those receiving routine care.
Site Logo
May 11th 2021

Variability of COPD Inhaler Coverage in Medicare Part D

Benjamin Wormser, MD Mariana P. Socal, MD, PhD, MPP, MSc Gerard Anderson, PhD
Although most Medicare Part D plans cover guideline-recommended outpatient chronic obstructive pulmonary disease (COPD) inhalers, the utilization controls applied to these therapies vary by plan type.
Site Logo
May 6th 2021

Quality, Health, and Spending in Medicare Advantage and Traditional Medicare

Eva DuGoff, PhD, MPP Ruth Tabak, MPP, MPH Tyler Diduch, MS Viviane Garth, BA
In a review of literature published since the Affordable Care Act’s passage, more than half of analyses find that Medicare Advantage outperforms traditional Medicare on quality, health, and cost outcomes.
Site Logo
April 21st 2021

Medicare APMs at a Crossroads

François de Brantes, MS, MBA Valinda Rutledge, MBA Kevin Bozic, MD, MBA
To be sustainable and successful, Medicare alternative payment models (APMs) have to attract and retain high and low performers. That requires a different approach to pricing and evaluation.
CMMI Remains Dedicated to Value-Based Care Despite Pause to Some Models, Fowler Says
April 20th 2021

CMMI Remains Dedicated to Value-Based Care Despite Pause to Some Models, Fowler Says

Laura Joszt, MA
During her opening plenary at the NAACOS Spring 2021 Conference, Liz Fowler, PhD, JD, deputy administrator and director of the Center of Medicare and Medicaid Innovation, highlighted how the center is taking a pause to reassess its models and what is coming next.
Site Logo
April 15th 2021

Post-SNF Outcomes and Cost Comparison: Medicare Advantage vs Traditional Medicare

Adrianne W. Casebeer, PhD Richard Schwartz, BS Harmit Patel, MS Ariel Caplan, BS Rituparna Bhattacharya, PhD Charron Long, PharmD Anup Sharma, MD Tich Changamire, MD Claudia Uribe, MD Chuck Stemple, DO Kali Thomas, PhD Mark Newsom, MS Phil Painter, MD William Shrank, MD Courtney R. Brown, PharmD
Patients enrolled in Medicare Advantage had better outcomes and lower cost following skilled nursing facility (SNF) discharge than patients enrolled in traditional fee-for-service Medicare.
<1
...
345678>

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