Insurance

Real-world cost barriers and insurance denials contribute to early discontinuation of injectable glucagon-like peptide-1 (GLP-1) receptor agonists, reducing their effectiveness for weight loss, explains Hamlet Gasoyan, PhD, Cleveland Clinic.

Supported value-based care improves prenatal care while reducing neonatal intensive care unit stays, preterm birth rates, low birth weight rates, and costs for mothers and infants.

A private oncology shared savings plan reduced colon cancer treatment costs. Results varied by tumor, with none in breast cancer and mixed effects in lung cancer.

Constance Blunt, MD, medical oncologist, Mary Bird Perkins Cancer Center, discusses the potential consequences of losing free health care screening coverage.

Patients who remained on treatment, especially at higher doses or on tirzepatide, were more likely to achieve clinically meaningful weight loss and improved glycemic control.

Adolescents face significant barriers to obesity medication access, despite a surge in prescriptions. Discover the disparities and potential solutions in obesity care.

Accessing medical and social resources for patients, heavy administrative burden, and lack of data integration are barriers to Medicaid managed care organization care coordinators’ job performance.

David Awad, PharmD, BCOP, says pharmacists play a growing role in managing access, safety, and toxicity for these therapies, ensuring treatments are appropriate and sustainable in real-world oncology practice.

Rural marketplace rating area change in Texas did not increase enrollment but increased share of enrollment in gold plans.

Constance Blunt, MD, medical oncologist, Mary Bird Perkins Cancer Center, shares how one mobile health care initiative is addressing critical barriers to medical access for underserved populations.

A score was developed to measure patient risk from payer utilization management policies and its relationship to real-world US commercial payer utilization management policies.

Payers should consider providing higher reimbursement rates and/or preferred pharmacy networking status for pharmacies that provide chronic medications in blister packs for patients.

Mental health outpatient services decreased in adults aged 65 years and older who were eligible for Medicare.

Decisions made during the first few months of the Trump administration do not inspire confidence in Ali Khawar for further protections for parity in coverage of mental health.

A new State of Drug Access report shows that more than 40% of people living in the US could not afford their prescribed drugs.

Lindsey Leininger, PhD, and Allister Chang, MPA, highlight the potential of laundromats as accessible, community-based settings to support Medicaid outreach, foster trust, and connect families with essential health and social services.

It is unclear whether Congress would pass a law to codify or expand on the Mental Health Parity and Addiction Equity Act should the federal rule be appealed by the Trump administration, according to Ali Khawar.

The repeal of the federal rule could leave those with mental health and substance use disorders at risk of losing coverage for their treatment.

Veterans primarily receiving care through the Department of Veterans Affairs (VA) similarly used dental and vision services under Medicare Advantage (MA) and traditional Medicare, challenging the justification for full MA capitated payments based on supplemental benefits.

Emma Achola-Kothari, PhD, highlights the need to expand Medigap access for Medicare beneficiaries younger than 65 years and calls for future research connecting access barriers to health outcomes.

Emma Achola-Kothari, PhD, explains that younger Medicare beneficiaries without supplemental coverage face high costs, while dual-eligible beneficiaries in Medicare Advantage plans struggle with provider access.

Emma Achola-Kothari, PhD, explains that Medicare beneficiaries younger than 65 years without supplemental coverage face greater financial and access barriers to care, while dual-eligible individuals experience fewer of these challenges.

Covered California and Health Net’s novel data exchange initiative significantly improved quality measurement and potentially reduced costs by more than $640,000.

Proposed Medicaid cuts in the Republican budget proposal hold significant implications for health care access and coverage.

The Maryland All-Payer Model was associated with an increase in population-based rates of elective major joint replacements, with a more pronounced effect observed in Maryland-only hospitals.