Insurance

In the midst of a government shutdown, former House Speaker Paul Ryan urges clear policies, AI innovation, and patient-focused solutions to build a sustainable US health care system.

AI can transform health care by processing vast data, enhancing decision-making, and addressing biases, but needs remain for transparency and human oversight.

Ratna Kiran Bhavaraju-Sanka, MD, and Beth Stein, MD, advocate for improved proactive management of myasthenia gravis (MG) for better patient outcomes.

Experts at CHEST 2025 highlight rising costs, insurance complexity, and workforce shortages as major barriers to health care access in the US.

New research highlights rising opioid use disorder (OUD) diagnoses among youth, emphasizing the need for improved screenings and mental health support.

The AMCP Nexus 2025 conference will bring together professionals to discuss drug access and policy, as well as the future of pharmacy.

Liver Awareness Month raises awareness of liver disease causes, risks, symptoms, and prevention, highlighting individual actions and policy efforts.

Susan Escudier, MD, FACP, of Texas Oncology, suggests actionable insights to improve equitable access to patient cancer care

Medicare Advantage grocery supplemental benefit use is associated with increased outpatient care, suggesting that policy changes allowing for nonmedical supplemental benefits could improve beneficiaries’ health, especially for dual-eligible beneficiaries.

Melanie T. Turk, PhD, RN, discusses her study on nationwide challenges program suppliers face in implementing the Medicare Diabetes Prevention Program (MDPP).

Counseling patients with obstructive sleep apnea on using GLP-1s effectively prior to starting treatment can help ensure adherence, said Matthew Biszewski, PharmD.

Adults with diabetes were 24% less likely to visit an emergency department in 2021 than in 2019.

Payer contracts should incentivize the delivery of comprehensive, total-person cancer care, says Brian Mulherin, MD.

Infliximab biosimilars created price competition causing insurance claims costs for infliximab originator and infliximab biosimilars to decrease, generating significant savings to the health care system.

Despite systemic challenges, oncology practices use value-based care, community partnerships, and clinical trials to improve patient access and outcomes, says Brian Mulherin, MD.

Research reveals that Medicaid accountable care organization (ACO) designs significantly impact maternal health outcomes, highlighting the importance of structural partnerships in care delivery.

Laxmi Patel of Savista discusses how the Budget Reconciliation Act could widen Medicaid coverage gaps and strain hospitals across states.

Prior authorizations for health plans will soon implement AI to streamline the process and potentially improve patient outcomes.

Today, Amgen announced the launch of AmgenNow, a direct-to-patient program offering evolocumab (Repatha) at nearly 60% below the current US list price.

This article examines how prices, insurer payments, and patient payments for outpatient surgeries differ by site of care and network status.

Research highlights disparities in anti-obesity medication use and metabolic and bariatric surgery.

Among Medicare Advantage enrollees, the mortality of Hispanic enrollees in Puerto Rico was significantly higher than that of Hispanic enrollees in the US during 2010-2022.

This national study of neonatology services found no clear evidence that state surprise billing regulations influenced prices or provider network participation for the commercially insured.

To mark the 30th anniversary of The American Journal of Managed Care, each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The October issue features a conversation with Ge Bai, PhD, CPA, professor of accounting at Johns Hopkins Carey Business School and professor of health policy and management at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

An eHealth survey revealed widespread confusion, low awareness of 2026 Medicare plan changes, and growing interest in artificial intelligence support.