Health Care Cost

Patty Taddei-Allen, PharmD, MBA, examines how co-pay accumulators, maximizers, and AFPs shift costs, impact rebates, and create access challenges for patients.

At AMCP 2026, Adam Colborn, JD, warns the Alternatives to PAIN Act may expand access but risk destabilizing Medicare Part D and limiting plan participation.

The 2026 Regional Diabetes Summit is taking place from April 28 to 29, 2026, in Wilmington, Delaware.

Ben Urick, PharmD, PhD, examines GLP-1 coverage gaps and real-world evidence challenges shaping payer decisions and obesity treatment access.

Experts at AMCP 2026 urged smarter oncology management amid rising costs, complex therapies, and fragmented oversight across plans.

High co-payments for potentially curative cell and gene therapies create avoidable access barriers; value-based insurance design should eliminate patient cost sharing for these therapies.

The expiration of subsides for health coverage starting in 2026 has left millions facing higher premiums with little notice.

The authors updated a diagnosis list to identify low-acuity emergency department visits by veterans and applied it to examine trends and predictors of veterans’ low-acuity utilization.

Patty Taddei-Allen, PharmD, MBA, warns that co-pay accumulators and maximizers may lower plan costs but increase patient burden and disrupt medication adherence.

Adam Colburn, JD, highlights 3 federal bills to expand value-based care, digital therapeutics, and pharmacist reimbursement across Medicare and Medicaid.

Complex Medicaid patients randomly assigned to receive outpatient social worker care coordination services experienced increased hospitalizations but no differences in emergency department visits or costs.

The increased costs of premiums after the expiration of enhanced subsidies have led to an increased percentage of those not able to make their payments.

Rapid advances in precision oncology are exposing gaps in testing, treatment access, and care delivery, challenging managed care to keep pace.

John Barkett, MBA, discusses recent regulatory proposals to make massive health plan price files more usable.

Esketamine's monotherapy approval and new real-world data are forcing a reckoning for managed care.

A cost model shows anti-VEGF savings only when high injection burden offsets device fees and reading time in AI home OCT vs clinic OCT.

Why Medicaid-covered kids struggle to see pediatricians: low reimbursement and practice deserts in low-income ZIP codes create real barriers to care.

Major health plans cut millions of preapproval hurdles, add 90-day continuity protections, and push real-time e-authorization to speed care access.

Manufacturer-sponsored biologic coupons have decreased since 2018, with rising per-claim values, impacting patient costs and formulary incentives.

Social determinants of health can delay access to NGS, limiting targeted therapy use and survival outcomes in advanced cancers.

ACIP changes threaten vaccine coverage and raise costs, according to a roundtable of experts warning of widening disparities and long-term public health risks.

From teledermatology billing to rural outreach and transplant advances, new studies and presentations reveal shifts in access, equity, and patient outcomes.

Findings from a randomized controlled trial on reducing information barriers for consumers selecting primary care clinics in a tiered network design demonstrate limited marginal effect of the intervention.

Inpatient encounters for Medicare patients 65 years and older are associated with higher coding intensity compared with commercially insured, Medicaid, or self-pay hospitalizations for those same individuals prior to age 65 years.

This retrospective analysis examines employees with obesity and reports on glucagon-like peptide-1 receptor agonist use, comorbidities, and work outcomes over time.