Reimbursement

CMS introduced the GENEROUS Model to reduce Medicaid drug costs, enhance access, and improve health outcomes for beneficiaries starting in 2026.

The White House announced significant drug pricing cuts for GLP-1s for diabetes and obesity for Medicare and Medicaid beneficiaries and on TrumpRx.

Experts analyze how Trump's drug pricing policies, including Most Favored Nation (MFN) and tariffs, reshape pharma markets and impact patient costs and access.

Confusion around how to verify work hours could leave millions unenrolled after the passing of the One Big Beautiful Bill Act.

Experts discuss the evolution of cancer care, emphasizing value-based approaches, precision oncology, and the importance of multidisciplinary collaboration for improved patient outcomes.

Individuals with both low incomes and health problems were more likely to gain employment when covered by Medicaid.

Payers cited high upfront costs, long-term uncertainty, and narrow coverage criteria as factors continuing to limit access and reimbursement innovation.

Physician burnout rates have decreased since the pandemic, but the likelihood of Medicare exits threatens access to underserved populations.

Telehealth medication abortion service requests double after the Supreme Court's Dobbs ruling, as patients seek accessible and cost-beneficial care.

ACOs serving patients with complex needs are on the rise, but policy changes are needed to support providers treating special populations.

Explore the implications of the Most Favored Nation Order on US drug pricing reform and its potential impact on patient access and innovation.

Laxmi Patel discusses proposed Medicaid reforms in HR 1, including work rules, coverage limits, and state-level risks for vulnerable populations.

New demands to follow the most favored nation executive order could lead to some compliance but it is unknown just how effective they will be across all health care.

Remote patient monitoring enhances cancer care by improving outcomes and reducing emergency visits, despite challenges in reimbursement and technology access.

Participating hospitals in the Prime Vendor Program and the 340B program spent nearly $37.3 billion more on drugs from 2010 to 2021.

Panelists at the Community Oncology Alliance Payer Exchange Summit discuss the urgent need for innovative reimbursement models in cancer care to match advancements in biomedical technology and drug discovery.

In the first part of this Q&A, Kathy Oubre, MS, discusses how likely it is that the most favored nation executive order will lead to price reductions in prescription drugs.

Under the second Trump administration, CMMI has published far more detail about peformance of Enhancing Oncology Model participants than under an earlier model, which spanned the administrations of 3 presidents.

A new report found that 9 of 10 small- to midsize businesses are not sure they will be able to provide health benefits to their employees in the near future.

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

The author discusses how Principal Care Management (PCM) enhances oncology care, improves patient outcomes, and boosts reimbursement opportunities for providers, yet remains underutilized.

Given the track record of good outcomes and savings, policy leaders must do more to promote growth of for-profit PACE programs, the author asserts.

Alina Salganicoff, PhD, discusses the immediate effects of the budget cuts to Medicaid as it pertains to women's health across the country.

Proposed changes to the Physician Fee Schedule aim to support community oncology, but the Inflation Reduction Act threatens financial stability for practices.

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