Payers

The planned separation would keep Aetna, CVS Caremark, and Oak Street Health together and move roughly 9000 drugstores into a new CVS Pharmacy.

Pharmacists outline new oncologic therapeutics, from pancreatic cancer to myeloma, and what high prices and crowded markets mean for payers.

A home-based oncology model using clear bagging is transformational for practices, protecting Medicare reimbursement and provider control, while lowering costs for patients, providers and payers

Costs of multimorbidity in older adults are climbing faster than its disability toll, and study authors say policy should look past single-disease programs.

An analysis of AccessHope case reviews found that experts recommended changes in more than 80% of cases. About half were implemented, saving a median of $18,636 per case.

At an AJMC® Stakeholder Interchange in Los Angeles, leukemia specialists described a region where hospital formularies push menin inhibitor starts into the clinic, emergency department (ED) physicians may not recognize differentiation syndrome, and capitated insurance contracts steer some patients with acute myeloid leukemia away from academic centers.

At AMCP Nexus 2026, payers said evidence, differentiation, and delivery now matter as much as FDA approval.

A poster at the ASCO Quality Care Symposium describes how a value-based care partnership used prior authorization data and pharmacist workflows to move eligible patients off flat dosing of pembrolizumab.

At an AJMC Stakeholder Interchange in Houston, leukemia specialists from academic centers and community practices said menin inhibitors work best in combination, warned that differentiation syndrome can strike months into therapy, and described payer rules that delay access even at flagship centers.

KFF finds 4.3 million Medicare beneficiaries will lose their MA or stand-alone Part D plans at the end of 2026 as PDP options keep shrinking.

At an AJMC® Stakeholder Interchange in New York, New York, leukemia specialists agreed that menin inhibitors fill a real gap in relapsed/refractory acute myeloid leukemia, but said that slow molecular testing, formulary rules, and thin community infrastructure still determine which patients get them and how fast.

Unclear ownership often leaves survivors without support, and coverage of social and psychological services could close the gap, says Bhatnagar.

Nevena Vicic, MSc, discusses first real-world data showing mRNA-1283 protected adults 65 and older from COVID-19 hospitalization in 2025-2026.

Povetacicept reduced proteinuria by 52% vs 4.3% with placebo at week 36 in adults with IgA nephropathy in the phase 3 RAINIER trial’s interim analysis.

At ASN Kidney Week 2026, experts said value-based kidney models improved dialysis starts, but payment cuts and MA growth are pushing practices out.

At CHEST 2026, 3 speakers explained why respiratory medications stay expensive, assessed what recent federal, state, and industry fixes have achieved, and urged clinicians to use their voices on behalf of patients.

Experts at CHEST 2026 urge pulmonologists to keep lung cancer in mind for younger patients who never smoked, to order screening and biomarker testing themselves, and to advocate for patients' access to care.

Selected presentations from “Reframing COPD: Phenotypes, Outcomes, Therapeutics, and the Future of Care Delivery,” a session on the opening day of CHEST 2026.

The editor in chief of Evidence-Based Oncology, who was recently named medical director of Precision Medicine for The US Oncology Network, discussed milestones met and those still to be achieved.

Alyssa Schatz, DrPH, MSW, of NCCN, explains how insurance shifts and drug shortages threaten access to cancer care.

In part 2, Susan Sabo-Wagner, MSN, RN, OCN, NEA-BC, discusses how earlier referrals, AI, and less prior authorization can improve cancer outcomes.

Susan Sabo-Wagner, MSN, RN, OCN, NEA-BC, discusses how data builds payer trust, reduces prior authorization, and expands access in community oncology.

The article explores the use of dose-intensive IV iron replacement to achieve long-term hemoglobin stability in patients with moderate to severe HHT-related bleeding. The approach recognizes what the author calls "the relentless and recurrent nature of HHT-associated bleeding," and may help patients achieve better quality of life.

Measles cases hit a year high. Here's what payers need to know about outbreak costs, MMR coverage, and plans to split the vaccine

In part 2, David Johnson, MD, MPH, discusses how real-time data can sustain gold carding, ease prior authorization burden, and ensure accountability.