Insurance

Laxmi Patel, chief strategy officer at Savista, outlines major impacts of the “One Big Beautiful Bill” Act on Medicaid and what hospitals can do to prepare for these changes.

Elise S. Tremblay, MD, MPH, explores potential policy solutions and research directions to address ongoing challenges in insulin affordability and access.

Proposed Affordable Care Act (ACA) premium hikes threaten health care access, with potential increases of over 75% for enrollees.

In this clip, Elise S. Tremblay, MD, MPH, explores factors behind fluctuations in insulin out-of-pocket costs and highlights the serious health consequences of persistently lower insulin use.

Medicare Advantage outperformed traditional Medicare on clinical quality measures before and during the COVID-19 pandemic; mid-pandemic, however, traditional Medicare narrowed the gap on some in-person screenings.

Elise S. Tremblay, MD, MPH, discusses her study on trends in insulin out-of-pocket costs and use disparities from 2008 to 2021, highlighting how health plan structure and income level influenced access and adherence.

This retrospective analysis explored the impact of infertility health benefit design on the use of infertility medications and procedures and pregnancy outcomes.

This study examined the impact of price transparency and prosocial messaging on patient engagement of price-protected consumers in seeking value-based care.

Key legal, ethical, and compliance considerations for managed care professionals navigating the evolving landscape of psychedelic-assisted therapy include regulatory risks, data privacy challenges, reimbursement limitations, and the need for culturally informed care models.

To mark the 30th anniversary of The American Journal of Managed Care (AJMC), 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 August issue features a conversation with Charles N. (Chip) Kahn III, MPH, the president and CEO of the Federation of American Hospitals and a longtime member of the AJMC editorial board.

At the recent regional Institute for Value-Based Medicine® event in Boston, Anasuya Gunturi, MD, PhD, Lowell General Hospital, was a panelist for the discussion, “Evolving Breast Cancer Care: Addressing Unmet Needs Across the Patient Journey.”

This Managed Care Cast episode explores how high costs and inconsistent insurance coverage for incretin mimetics impact obesity management and patient care.

Patients who experienced a formulary-related rejection of cariprazine for adjunctive treatment of major depressive disorder had significantly higher hospitalization rates than those with approved claims.

Mental health, care of acute and chronic conditions, primary care access and prevention, and maternal and perinatal health were identified as key focus areas among a majority of states.

There is a great need to streamline the process from the tissue sample to the diagnostic lab, whether it's genomic or immunohistochemistry, Robert Kratzke, MD, says.

According to the American Medical Association, blame for the ongoing physician shortage may lie with overly burdensome administrative processes, an antiquated Medicare payment system, and lack of education for residents in primary care and psychiatry.

Revumenib is now the sole targeted therapy recommended by the National Comprehensive Cancer Network for KMT2A-rearranged acute leukemia, which opens a path for payers, said Ivo Abraham, PhD, RN, of The University of Arizona.

Apixaban would still cost patients 9 times more through the Eliquis 360 Support program than with commercial insurance.

Robert Kratzke, MD, urged insurance providers to prioritize fast biomarker testing in non–small cell lung cancer, saying it’s both cost-effective and life-saving.

Medicare inflation rebates fail to curb rising drug prices, highlighting the need for further policy action to control costs.

A webinar held by KFF on July 9 emphasized the immediate effects of the new budget bill, highlighting the impacts on Medicaid and health spending in the next decade.

Families caring for individuals with Duchenne muscular dystrophy (DMD) face significant financial burdens from necessary home and vehicle modifications to enhance quality of life.

Access to and affordability of immune checkpoint inhibitors, which can be lifesaving if patients receive them on time and under optimal circumstances, continue to top the list of reasons behind outcomes disparities for patients who have private insurance vs those who remain uninsured.

From the impact of rising grocery prices to disparities in myeloma outcomes, check out news from the Center on Health Equity & Access this past week.

The decision by the Supreme Court has major implications on which preventive services are required to be covered by insurance companies under the Affordable Care Act.