Insurance

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.

The cap cut quarterly spending by the hundreds and lowered A1c levels but failed to expand the pool of insulin users.

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.

Employers can use price transparency data to reconsider their choice of carriers or plans, negotiate prices with their carriers, and steer employees toward high-quality, reasonably priced providers.

Half of working-age Medicaid enrollees face disenrollment under national work requirements, despite having greater functional impairment than those who would comply.

A new analysis projects that millions will lose Medicaid expansion coverage—including many who are working, exempt, or have serious health needs.

New studies show 2024 IRA Medicare drug caps and expanded subsidies cut cost-related nonadherence, especially for those with chronic disease.

Making health care prices public was supposed to cut costs. The reality is more complicated.

Medicare Advantage enrollees with advanced cancer had higher hospice use than those with traditional Medicare, highlighting disparities in end-of-life care.

Predictive risk scores created using administrative claims and publicly available social determinants of health data strongly predicted severe diabetes complications for Maryland Medicare fee-for-service beneficiaries.

New studies link extreme heat, obesity coaching gaps, cancer delays, ACA cost spikes, and income inequality to widening global health disparities.

A survey of marketplace enrollees revealed that they expect to cut back on basic household expenses to keep insurance coverage.

One in 4 Medicaid managed care organization sanctions are not remediated, revealing inconsistent state and federal oversight and the need to standardize CMS reporting and enforcement guidelines.

Legislation that passed the Senate will introduce reform in how pharmacy benefit managers are addressed by CMS starting in 2028.

The website officially launched on February 5, introducing a key part of the Trump administration’s health care plan.

Cost barriers push Latino adults to delay care, raising emergency department visits.

Susan Cantrell, CEO of AMCP, discusses the impact of the CDC's recent changes to the childhood immunization schedule and the role of managed care pharmacy in addressing them.

As Medicare Advantage grows, first-time enrollees demonstrate increasing demographic and clinical diversity, indicating that benefits should be designed to reflect the population’s changing composition.

Experts unpacked MFN drug pricing, expired ACA subsidies, and IRA fallout for community oncology in a recent webinar.

Medicaid managed care organizations should prioritize children in low-opportunity neighborhoods to optimize health care utilization, improve minority health, and address health-related social needs.

Employers and members can cut GLP-1 weight-loss costs with carve-outs, split payments, and transparent, updated price guides.

Scripta allows consumers to compare prescription prices, coupons, and insurance options in one place, helping patients and employers find affordable meds and smarter choices.