Payers

Adam Brufsky, MD, PhD, addresses how the COVID-19 pandemic affected breast cancer screening rates across Pittsburgh.

Utilizing the Health Insurance Disparities Index for assessment, the authors found that New York’s Medicaid health maintenance organizations (HMOs) outperformed Medicaid HMOs nationally in addressing health care disparities from 2019 to 2023.

Only 4% of NIH prevention projects target health disparities, revealing a major gap between equity research and real-world implementation.

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

Experts at AMCP Nexus 2025 highlighted how real-world data can improve CAR T-cell therapy access and outcomes.

A multidisciplinary approach that includes addressing social determinants of health reduces time to remission despite higher initial costs.

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

Payer contracts should incentivize the delivery of comprehensive, total-person cancer care, says Brian Mulherin, MD.

Allergen immunotherapy was associated with reduced medication use and improved asthma control for up to 9 years.

Laxmi Patel of Savista discusses how the Budget Reconciliation Act could widen Medicaid coverage gaps and strain hospitals across states.

Expanding clinical trial eligibility in slow-developing follicular lymphoma enhances patient access to innovative therapies and addresses healthcare disparities.

The study confirms that biologics are highly effective in real-world HS management, and highlights the need for a comprehensive treatment strategy considering both skin symptoms and systemic health.

Oncology utilization management often frustrates patients and payers, but collaboration and artificial intelligence can streamline processes and improve care quality, according to Vishnukamal Golla, MD, MPH.

John Byrnes of Banner|Aetna emphasizes collaboration and data-driven strategies to enhance care quality, access, and affordability in health care.

This case study describes Tennessee’s process for convening key stakeholders to develop uniform payment guidelines to encourage increased preventive service delivery.

To mark the 30th anniversary of The American Journal of Managed Care, each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The September issue features a conversation with Dora Hughes, MD, MPH, chief medical officer and director of the Center for Clinical Standards and Quality at CMS.

A new joint guideline from the American Heart Association and the American College of Cardiology emphasizes early treatment, close perinatal blood pressure monitoring, and incorporating the PREVENT risk calculator to personalize care.

Joanne Mortimer, MD, FACP, FASCO, discusses the practical applications and limitations of circulating tumor DNA (ctDNA) testing in breast cancer, highlighting its role in guiding targeted therapy, challenges in patient communication and payer coverage, and unique barriers for male patients.

Patients with severe sickle cell disease experienced significant quality of life improvements after receiving exagamglogene autotemcel gene therapy.

Targeted “Food is Medicine” interventions can help individuals with diet-sensitive chronic conditions improve their health, but nationally representative survey and qualitative interviews showed low awareness despite high interest among respondents.

Matias Sanchez, MD, a hematologist-oncologist at University of Illinois Health, discussed strategies to deliver cutting-edge multiple myeloma care while mitigating costs.

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.

The FDA approved zopapogene imadenovec, the first therapy for recurrent respiratory papillomatosis, providing an option beyond repeated surgeries to manage the rare condition.

Children with spinal muscular atrophy (SMA) showed motor function improvements after switching to onasemnogene abeparvovec following prior treatment with nusinersen or risdiplam in a real-world study.

DYNE-251 received FDA breakthrough therapy designation, showcasing its potential for patients with Duchenne muscular dystrophy (DMD).