Insurance

The 2018 permanent authorization of dual-eligible special needs plans marked a significant long-term commitment by policy makers and coincided with substantial growth in plan offerings and enrollment.

OUD diagnoses have declined, but use of medication to treat OUD has increased among Medicaid beneficiaries, highlighting policy gains and ongoing state-level disparities.

Black Maternal Health Week spotlights disparities, Medicaid postpartum coverage gains, and ongoing policy efforts to reduce maternal mortality.

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

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.

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.

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.

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

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.

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.