May 5th 2025
To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes reflections from a thought leader on what has changed over the past 3 decades and what’s next for managed care. The May issue features a conversation with John Michael O’Brien, PharmD, MPH, a member of AJMC’s editorial board and the president and CEO of the National Pharmaceutical Council. This interview has been lightly edited for clarity.
At-Home Cholesterol Screening Accessible Through New Program
September 30th 2024The innovative program from the Family Heart Foundation includes being able to order a free test kit for an at-home blood lipid panel and track your results online, as well as the ability to discuss the findings with care navigators and health care providers.
Read More
Role of the Pharmacist in the Care Team to Contain Costs in Oncology
September 28th 2024The pharmacist is a critical member of the care team to help manage patients on treatment and contain costs of cancer care, said Kirollos S. Hanna, PharmD, BCPS, BCOP, FACCC, director of pharmacy, Minnesota Oncology.
Watch
Uplifting Rural Behavioral Health: Leveraging Grants for Lasting Impact
September 27th 2024This interview accompanies the fourth podcast in our National Recovery Month series with Amy Herschell, PhD, associate vice president, Program Implementation and Evaluation, Community Care Behavioral Health Organization, part of the UPMC Insurance Services Division, and Jessica Meyers, MSEd, senior advisor for implementation, UPMC Center for High-Value Health Care.
Watch
State Policy Opportunities to Control Health Care Prices: A CPR Report
September 25th 2024Catalyst for Payment Reform (CPR) explores stakeholder perspectives in Florida, Michigan, and Nevada, revealing both the challenges and opportunities states face in reforming health care pricing structures.
Read More
New FTC Lawsuit Against PBMs Has Broad Implications for Pharmaceuticals, Ted Okon Says
September 24th 2024Ted Okon, MBA, executive director of the Community Oncology Alliance, spoke with The American Journal of Managed Care® about how the Federal Trade Commission's (FTC) lawsuit against pharmacy benefit managers (PBMs) could affect the future of pharmaceuticals and oncology.
Read More
Extended Time in ED Linked to Reported Racial Discrimination and Patient Dissatisfaction
September 24th 2024Boarding times in the emergency department (ED) have risen nationally, but the implications for health equity have remained understudied. This study investigated whether prolonged ED boarding contributed to perceived racial discrimination and dissatisfaction with care.
Read More
Medicare High-Value Drug List Model Could Lower Out-of-Pocket Costs for 4 in 10 Beneficiaries
September 23rd 2024The proposed Medicare High-Value Drug List Model, also known as the Medicare $2 Drug List, could have modestly reduced out-of-pocket costs for 38% of beneficiaries if implemented in 2021.
Read More
CMMI's Latest Payment Models Address Health Disparities, but Challenges Remain
September 22nd 2024"As CMMI continues to test new equity adjustments, it is important that changes be grounded in scientific principles with extensive testing and validation to ensure the tightest linkage to social needs and health outcomes for underserved communities across the entire US," authors wrote.
Read More
The authors examine how insurer and patient out-of-pocket payments for advanced prostate cancer differ by drug and health plan type and describe the relationship between these payments and utilization.
Read More
US Health Care System Ranks Last Overall Among Other High-Income Countries
September 19th 2024The US health care system is underperforming despite high spending, and reform is needed in areas like insurance coverage, primary care, and equity to improve overall health outcomes and efficiency.
Read More
It’s Time to Address Our Nation’s Health Care Price Crisis
September 18th 2024This commentary introduces Catalyst for Payment Reform’s and the Employers’ Forum of Indiana’s new campaign, Price Crisis, which will mobilize individuals, employers, and policy makers with evidence, guidance, and resources to take meaningful actions.
Read More
Eliminating Low-Value Services Can Improve Access to Innovative Cancer Treatments
September 13th 2024With the advances in cancer care, focus has mostly been on lamenting the high cost of these innovations instead of making patients and populations healthier, said A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.
Watch
Dr Jennifer Green Weighs in on CMS Drug Prices, the Future of Combination Therapies
September 12th 2024Jennifer Green, MD, of Duke University, explained that while CMS-negotiated drug prices under the Inflation Reduction Act (IRA) may not immediately lower patients' costs, they could improve access to expensive medications.
Watch
Biden-Harris Administration Expands Mental Health Coverage Protections Nationwide
September 10th 2024Ali Khawar, Employee Benefits Security Administration, US Department of Labor, believes the final rule will be a benefit to employers and health plans that are trying to do the right thing and offer robust mental health benefits or substance use benefits.
Read More
Optum Care's Dr Ken Cohen Advocates for Comorbidity-Based GLP-1 Tiering for Patients With Diabetes
September 10th 2024Ken Cohen, MD, of Optum Care, advocates for glucagon-like peptide 1 (GLP-1) tiering for patients with diabetes based on comorbidities, like body mass index (BMI) and cardiovascular disease (CVD).
Watch
UPMC's Dr Manisha Jhamb Urges Better Kidney Disease Awareness, Integrated Care
September 4th 2024Manisha Jhamb, MD, MPH, of the University of Pittsburgh Medical Center (UPMC), is excited about CMS's negotiated drug prices under the Inflation Reduction Act (IRA) for patients with kidney disease; conversely, she highlights the challenge of low kidney disease awareness.
Watch