Reimbursement

Medicare Advantage beneficiaries face forced disenrollment in 2026 as plan exits drive coverage termination, pushing millions toward traditional Medicare and Part D’s $2100 cap.

The editor in chief of Evidence-Based Oncology lauds Congress' authorization of a path for Medicare coverage for multicancer early detection.

Oral semaglutide (Wegovy; Novo Nordisk) expands GLP-1 weight-loss options, but pharmacy budgets and health care cost pressures persist.

Collaborative care use has surged 26-fold, but state reimbursement gaps leave many patients without integrated mental health care in primary care.

The ACCESS Model signals a shift toward outcome-aligned payments and a necessary reframing of what “value” actually means.

AI revolutionizes pharmacy by automating workloads, enhancing patient care, and navigating drug pricing challenges amid evolving federal policies.

The most-viewed content focused on the “One Big Beautiful Bill,” the Most Favored Nation drug policy, and other changes under the Trump administration.

A reimbursable, team-based remote blood pressure monitoring program significantly improved hypertension control in patients with multiple chronic conditions.

Readers of PHEO this year found value in research, conference coverage, and insights that touched on health outcomes and care quality.

Federal policy changes, the push for fair pricing, and growing competition in the drug pipeline were major topics at this year’s meeting.

Leaders describe how shared data, theranostics programs, and coordinated clinical trials support independent practices and advance value-based cancer care.

How strategic partnerships in oncology can enhance patient care by addressing diverse needs through collaboration.

Oncology leaders warn that declining reimbursements and policy gaps threaten patient access and drive inequities in cancer care.

Recent political shifts impacting health policy and access to care for millions dominated the news in 2025.

Both health care plans brought forward by Republican and Democratic senators, respectively, did not garner enough support from across the aisle.

A study finds that community oncology practices limit financial toxicity for patients with cancer, offering significant cost savings compared with hospital outpatient settings.

A new study shows fee-for-service care is linked to higher odds of low-value surgery, suggesting salaried models may reduce unnecessary procedures.

Avoiding losses of coverage due to administrative barriers can be done with a focus on making some of the processes automatic.

The uninsured rates may skyrocket when Medicaid work requirements go into effect and if the Affordable Care Act (ACA) subsidies are not extended.

The quick turnaround between the introduction of Medicaid work requirements and implementation could leave many states spread thin, explains William Schpero, PhD, MPhil, MPH

Requiring individuals on Medicaid to report their work hours has been attempted in other states previously, with mixed results.

A vote on the House floor allowed for the government to reopen immediately, but the fight over the extension of ACA subsidies still goes on.

In this investigation, the authors evaluated the impact of a voluntary transition to risk-based contracts under Medicare Advantage on health care use.

The introduction of more stringent work requirements for those enrolling or renewing their Medicaid coverage can affect both children and adults.

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