Insurance

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.

Jonathan Wrathall, PhD, explains that his 2 studies found social needs and insurance type strongly predicted food insecurity.

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.

ACA enrollment drops 21.5% in 2026 after enhanced subsidies end. Deductibles hit record $3786 as enrollees shift to high-deductible bronze plans.

Diana Verrilli, MS, of Navista breaks down the regulatory, payer, and cybersecurity pressures threatening community oncology practices—and maps a path forward.

Investigators found major variation in prior authorization rules across commercial insurers, highlighting limited standardization and transparency.

This study evaluated differences in racial and ethnic disparities in surgical outcomes between Medicare Advantage and traditional Medicare beneficiaries, finding consistent but nonuniform smaller disparities within Medicare Advantage.

Fears that the telemedicine boom would send health care costs soaring haven’t been borne out, a major new study finds, and the timing couldn’t be more critical for federal policy makers.

Here is a policy briefing for chief medical officers and managed care leaders on key pressure points about the Medicaid funding cuts.

Their study found cost nudges had minimal effect on clinic selection, as 85% already chose lower-cost tiers, suggesting tiered benefit design works.

Hospital at home is linked to lower mortality and ED use vs inpatient care in Medicare patients.

This week, a Capitol hearing spotlights Medicare fraud gaps, reports warn of equity setbacks, community oncology boosts survival, and Medicaid work rules loom.

Experts at AXS26 laid out why advanced therapies are underutilized and what payers, providers, and manufacturers must do together to change that.

Chris Johnson, MBA, explains how retail-based pediatric clinics and smart tech can expand Medicaid access and streamline visits.

The new work requirements for Medicaid eligibility, included in the One Big Beautiful Bill Act, will officially be required in January 2027.

A new Commonwealth Fund report finds persistent racial health disparities nationwide despite coverage gains, with major gaps in care, access, and outcomes.

Specialty pharmacies play a critical role in connecting patients with assistance programs to combat growing financial complexities.

Justin Favaro, MD, discusses independent oncology models, ACA challenges, and strategies to reduce health care costs at IVBM Charlotte 2026.

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.