Health Care Cost

Experts at AMCP Nexus say biosimilar launches should prompt payers to revisit step therapy and measure value beyond market share.

Three experts apply policy, pharmacy operations, and member-level lenses to the same prescriptions to show why cost at the counter decides adherence.

CEO Susan Cantrell previews AMCP Nexus 2026, discussing AI, drug pricing, emerging therapies, and a decade of change in managed care pharmacy.

Nearly half of working-age adults were inadequately insured in 2026, and half went without needed care due to cost, a Commonwealth Fund survey found.

AMCP Nexus 2026 brings managed care leaders to San Diego October 26-29 to tackle Medicare negotiation, drug pricing policy, AI, and patient access.

Medicare’s GLP-1 Bridge program aims to expand obesity treatment, but eligibility hurdles and drug costs leave many seniors paying hundreds monthly.

Birth centers are unavailable in 10 states, and 39% of birth center births are self-pay, as licensing and Medicaid pay limit access, a report finds.

Siva Mohan, MD, explains how drug costs drive silent nonadherence, PA burden, and biosimilar hesitancy, and what payers can do about it.

HR 1 brings Medicaid work requirements and narrower immigrant eligibility by January 2027, and CBO projects 10 million more uninsured by 2034.

New non-CF bronchiectasis in Medicare is tied to high health care use and $8998 PPPM FFS spending; prevalence is highest in older women.

Medicare drug price negotiations lowered out-of-pocket costs for some beneficiaries, but those reaching the annual Part D cap saw no direct savings.

Amanda Velazquez, MD, discusses GLP-1 formulary strategies, overcoming prior authorization hurdles, and building scalable obesity care infrastructure.

Older adults on Medicare report the best access to care among 10 countries but more cost-related problems and higher out-of-pocket spending.

COA's Nicolas Ferreyros discusses real-world survival data for community oncology, health system consolidation, and barriers to CAR T-cell access.

The study authors note there is an urgent need for "innovative value-based and alternative payment models of care."

The trade group says CMS lacks authority to impose GLOBE, which is set to begin January 1.

A legal fight over a single amino acid could set retatrutide's exclusivity window, its Medicare negotiation clock, and its competitive future.

CMS finalized Transparency in Coverage updates as a researcher warns ghost rates and missing inpatient data limit payer price files.

A traditional Medicare out-of-pocket (OOP) cap could reduce beneficiaries’ costs but increase annual federal spending by $39 billion to $96 billion.

Build scalable obesity care with multidisciplinary teams, clear triage, and monitoring protocols; address GLP-1 gaps, Medicare access and price barriers, including oral GLP-1.

Phase 3 wins for ianalumab and dazodalibep bring targeted therapies closer for Sjögren disease as patients face diagnostic delays and high costs.

Invivyd's VYD2311 shows superior safety and tolerability vs Comirnaty in the phase 3 LIBERTY trial, with no vaccine interference.

CMS finalized the mandatory GLOBE Model, tying Part B drug rebates to international prices in areas covering 25% of beneficiaries from Jan. 1, 2027.

FDA accepted United Therapeutics' sNDA for inhaled treprostinil in IPF. Here's what it could mean for patient access, coverage, and costs

Average stand-alone Part D premiums are projected to rise by less than $1 a month as a temporary subsidy program ends after 2026.

Aligning financial incentives with patient-centered care is becoming an increasingly complex path to navigate within oncology.

A US modeling study found tirzepatide and semaglutide cost-effective for MASH, while resmetirom exceeded the $100,000/QALY threshold.