Health Care Cost

Laxmi Patel, chief strategy officer at Savista, outlines major impacts of the “One Big Beautiful Bill” Act on Medicaid and what hospitals can do to prepare for these changes.

Clayton Irvine, PharmD, MBA, MS, discusses strategies to address payer-driven biosimilar and prior authorization challenges through integrated digital solutions, while advocating for flexible, regularly reviewed treatment pathways supported by molecular tumor boards and artificial intelligence to balance standardization with personalized, biomarker-driven oncology care.

Elise S. Tremblay, MD, MPH, explores potential policy solutions and research directions to address ongoing challenges in insulin affordability and access.

Proposed Affordable Care Act (ACA) premium hikes threaten health care access, with potential increases of over 75% for enrollees.

In this clip, Elise S. Tremblay, MD, MPH, explores factors behind fluctuations in insulin out-of-pocket costs and highlights the serious health consequences of persistently lower insulin use.

A real-world study found that semaglutide prescriptions were associated with improvements in weight, blood pressure, and cholesterol, but also a $80 monthly rise in health care spending outside of drug costs.

Elise S. Tremblay, MD, MPH, discusses her study on trends in insulin out-of-pocket costs and use disparities from 2008 to 2021, highlighting how health plan structure and income level influenced access and adherence.

A new report from Bluesight reveals how automation and analytics are helping hospital pharmacy teams cut spending, manage shortages, and streamline procurement.

In this second part of his interview with The American Journal of Managed Care®, Sanjay Doddamani, MD, MBA, a former senior advisor to CMMI and founder and CEO of Guidehealth, continues a dialogue on the future of value-based care and the promise—and limits—of AI-enabled innovation, reflecting on challenges like rising Medicare costs and patients’ growing financial burdens.

Adults with type 2 diabetes, especially those in vulnerable groups, face higher risks of medical debt, low credit scores, and bankruptcy.

Large language models (LLMs) such as GPT-3.5 and GPT-4 may offer a solution to the costly and inefficient process of manual clinical trial screening, which is often hindered by the inability of structured electronic health record data to capture all necessary criteria.

President Donald Trump has sent letters to pharmaceutical companies, aiming to compel them to lower drug prices in the US to match the lowest prices offered in other developed nations, a move that could significantly reduce costs and disrupt the current system of pharmacy benefit managers.

Given trends in cost and use, insulin out-of-pocket cost reduction policies would be more efficient if they targeted members in high-deductible health plans with savings options and low-income patients.

This study examined the impact of price transparency and prosocial messaging on patient engagement of price-protected consumers in seeking value-based care.

Proceeding with hematopoietic stem cell transplantation (HSCT) is more cost-effective than delaying the procedure in patients with intermediate-risk acute myeloid leukemia (AML).

During a visit to AtlantiCare, CMS Administrator Mehmet Oz, MD, MBA, called for rural health systems to modernize IT infrastructure through the $50 billion Rural Transformation Fund, including through artificial intelligence (AI).

The rapidly increasing prescriptions for expensive specialty medications, rather than their price growth, are the primary driver of escalating dermatology Medicare Part D expenditures, necessitating policies that balance innovation, access, and affordability.

Investigators sought to measure and attribute out-of-pocket costs to cancer stage and by diagnosis.

According to the American Medical Association, blame for the ongoing physician shortage may lie with overly burdensome administrative processes, an antiquated Medicare payment system, and lack of education for residents in primary care and psychiatry.

States participating in the Cell and Gene Therapy (CGT) Access Model will be testing outcomes-based payments for sickle cell disease treatments.

Assertive community treatment, a strongly evidence-based practice for delivering care to individuals with schizophrenia and low health care engagement, is applicable to disengaged, medically complex patients.

Caroline Vovan, PharmD, CDE, highlights how ambulatory clinical pharmacists contribute to value-based care by managing chronic conditions, improving medication adherence, and reducing costs.

Sanjay Doddamani, MD, MBA, a former senior advisor to the Center for Medicare and Medicaid Innovation, and internist and cardiologist by training, explains how the Wasteful and Inappropriate Service Reduction (WISeR) Model hopes to work, and addresses concerns about delays and denials from revamped prior authorization processes.

Adam Colborn, JD, associate vice president of congressional affairs at AMCP, shares insights on the impact of the Most Favored Nation drug pricing order when it comes to access, affordability, and innovations in US health care.

Medicare inflation rebates fail to curb rising drug prices, highlighting the need for further policy action to control costs.