Insurance

Approximately 1 million Aetna members will need new coverage with the announcement that CVS will be leaving the Affordable Care Act (ACA) individual exchange business next year.

Experts urge for technology-driven, collaborative solutions as patients shoulder a growing burden of prescription costs.

New treatments for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) enhance patient care with gene therapies and new mechanisms of action on the horizon, explained Casey Koch, PharmD, from Select Health.

Early actions by the new administration signal major changes in health policy, taxes, and pharmaceutical pricing.

Medicaid beneficiaries face higher rates of pulmonary hypertension, with significant economic burdens and racial disparities in prevalence and costs.

Expanding Medicare coverage for glucagon-like peptide 1 (GLP-1) receptor agonists could significantly reduce obesity-related health issues, but it also risks adding tens of billions in new costs, highlighting the need for smart policy strategies to ensure access, affordability, and long-term sustainability.

Asembia's AXS25 Summit will unite more than 8000 key decision-makers to explore pharmacy innovation, artificial intelligence, policy, and patient care from April 27 to May 1 at Wynn & Encore in Las Vegas, Nevada.

On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.

Richard Hughes IV, JD, MPH, spoke about the upcoming oral arguments to be presented to the Supreme Court regarding the Braidwood case, which would determine how preventive services are guaranteed insurance coverage.

Sam Peasah, PhD, MBA, RPh, director of High-Value Health Care Value-Based Pharmacy Initiatives at UPMC Health Plan, discusses ways that health plans can help reduce the cost burden of medications to improve adherence.

The executive order targets lower drug prices through Medicare reforms, anticompetitive crackdowns, and transparency mandates.

JC Scott, CEO and president of The Pharmaceutical Care Management Association, discusses current efforts in increasing biosimilar adoption and pharmacy benefit manager (PBM) reform.

Galen Shearn-Nance, BS, and Johnie Rose, MD, PhD, of Case Western Reserve University, acknowledge key limitations of their study and prioritize areas for further research.

No significant differences in treatment or outcomes were found between most Medicare Advantage (MA) and fee-for-service (FFS) beneficiaries with breast cancer, but Black patients with FFS Medicare were less likely to receive standard treatment.

The California-based entities plan to offer new Medicare Advantage (MA) products in select counties by this fall.

As Medicare Advantage (MA) enrollment grows, Johnie Rose, MD, PhD, Case Western Reserve University School of Medicine, underscores the importance of ongoing research into outcomes for MA beneficiaries vs fee-for-service (FFS) Medicare beneficiaries.

Adam Colborn, JD, associate vice president for congressional affairs, Academy of Managed Care Pharmacy, highlights key policy updates that are impacting managed care pharmacy.

In 2021, UnitedHealth Group received 42% of the $33 billion in additional Medicare Advantage payments from differential coding.

This study examined postdiagnosis breast cancer treatment outcomes for Medicare Advantage vs fee-for-service (FFS) Medicare in Ohio and found no significant differences overall but disparities for Black patients with FFS Medicare.

Prior authorizations create substantial administrative and financial burdens on physicians and patients and can disrupt the continuity of care.

Best practices can help MA plans improve their Star Ratings performance while allow for strategies for medication adherence to grow.

The researchers emphasized the need for ongoing research and advocacy to further address drug affordability.

Tenacious efforts at every level, from the individual clinician to the hospital to the state to Congress, will be needed to make sure patients can access life-saving gene therapies for neuromuscular diseases.

Posters presented at the 2025 Muscular Dystrophy Association (MDA) Clinical & Scientific Conference show that therapeutic advances in treating spinal muscular atrophy (SMA) are not uniformly making it into the hands of patients who could benefit.

Michael Chernew, PhD, professor of health care policy and director of the Healthcare Markets and Regulation Lab, Harvard Medical School, shares how cost-sharing policies shape access to critical health care services and influence value-based insurance design.