Insurance

Dermatologists spend 13 hours weekly on prior authorization as health plans tout an 11% reduction in requests.

Existing rebates and manufacturers' gaming risk may limit these gains.

Kerry Rogers, MD, at The James, unpacks what these questions mean for patient counseling and clinical trial equity in chronic lymphocytic leukemia (CLL).

Medicare Advantage (MA) beneficiaries had similar optimal cancer treatment use and treatment timing as traditional Medicare (TM), with lower anticipated costs.

Robert Kratzke, MD, discusses how biomarker testing mandates and faster sequencing can improve access to precision lung cancer care.

Pharmacy eases lung cancer costs; pediatric cancer erases 40% income; BTKis widen CLL access; hospitals lag on translated aid; MN mandate ends NGS denials.

COVID-19-related Medicare spending and health care use declined after acute infection, with minimal excess costs by weeks 13 to 40 after diagnosis.

A secret shopper study found 9 in 10 online GLP-1 sellers issued prescriptions, often with minimal screening for eating disorders or clinical risk.

Senate Democrats introduced a bill to cap out-of-pocket costs at $5000 for traditional Medicare beneficiaries and expand low-income assistance.

Insurance and socioeconomic factors delay optimal anti-VEGF care for diabetic macular edema, worsening vision disparities.

National HIV Testing Day highlights how state policies, pharmacists, and long-acting therapies are reshaping access to HIV testing, PrEP, and PEP.

New research reveals complex treatment costs from MM strain patients and caregivers during active therapy, while pain goes undertreated at end of life.

Texas abortion ban worsens maternal mental health; SCD trials exclude 90% of adults; nutrition, hepatitis B, and cost-control gaps persist.

Broader cancer care networks were not consistently associated with lower Medicare Advantage disenrollment after cancer diagnosis.

Commercial health care costs are projected to grow 9% in 2027, driven by AI billing tools, pharmacy spend, and provider consolidation, per a PwC report.

Cancer trauma, drug pricing claims, abortion cost gaps, insurance denials affecting 1 in 5, and food insecurity's economic toll top this week's roundup.

During a White House briefing, Mehmet Oz, MD, discussed the expansion of Trump Rx and crackdowns on duplicate ACA enrollment and fraudulent hospice programs.

Coverage denials delay care, drive patients into debt, and erode trust in insurers—yet nearly half of affected patients never appeal.

Even spending just 5% of income on medical costs raises food insecurity risk by 80% for families with children, study finds.

Accountable care offers one of the most promising frameworks for stabilizing and expanding access, but only if policy is intentionally designed to support rural participation.

Research indicates that prior authorizations for drugs take physician practices and pharmacies 15 to 64 minutes to complete and cost $15 to $63 each.

This article provides a commentary on a news feature published on AJMC.com in 2025 titled “AI Seen as Key to Reducing Health Care Claim Denials, Survey Finds.”

Medicare FFS beneficiaries with metastatic cancer received broad genomic profiling more often than MA patients.

Insured patients paying over $15 in generic drug co-pays may save more buying direct through a direct-to-consumer pharmacy like Cost Plus Drugs

US health care faces massive shifts: rising ACA deductibles, federal health leadership shakeups, and major care gaps in women's health and dermatology.