Insurance

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.

Lindsey Valenzuela, PharmD, explains how cost, coverage gaps, and tech literacy hinder women’s access to early arrhythmia detection tools.

Robert Andrews, CEO of the Health Transformation Alliance, addresses Medicaid rebates, cost-shifting concerns, and value-based pricing trends.

Robert Andrews, CEO of the Health Transformation Alliance, discusses the implications of the new TrumpRx platform on drug pricing policy.

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.

Rilzabrutinib (Wayrilz; Sanofi) may improve immune thrombocytopenia (ITP) outcomes, enable early intervention, and enhance patient quality of life.

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.

Tory M. Wolff, MBA, discusses his study showing that frequent routine primary care visits may lower costs for higher-risk commercially insured adults.

Experian Health’s 2025 State of Claims survey shows rising denial rates, data errors, and low artificial intelligence adoption despite providers’ belief in its potential.

Laxmi Patel urges rural hospitals to align leadership early and build logic models to show how transformation funds can drive access, equity, and sustainability.

Laxmi Patel explains how providers can meet potential new Medicaid documentation requirements without harming patient access.

A RAND report shows Medicare’s 3-year insulin savings model cut costs, improved access for beneficiaries, and offers lessons for future drug pricing reforms.

Laxmi Patel urges hospitals to embed financial screening and simplify payment options to prepare for rising levels of uninsured patients from Medicaid changes.