Insurance

Several evidence-based health literacy resources may be beneficial in health plan settings to improve organizational health literacy, personal health literacy, and health equity.

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.

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.

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

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.

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

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, 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.

Physician groups under 2-sided risk–based Medicare Advantage provide care associated with higher quality and efficiency compared with care by these same groups under fee-for-service Medicare.

Laundromats offer a promising outreach setting for Medicaid payers because Medicaid enrollees represent a majority of laundromat users and have disproportionately high levels of unmet needs.

Asembia’s AXS25 Summit covered a variety of relevant topics in the pharmaceutical industry, from the effects of the new administration to how artificial intelligence (AI) is reshaping the patience experience.

Timely outpatient telepsychiatry care for Medicaid enrollees was associated with lower hospitalization rates and comparable overall costs, supporting its potential role in value-based care models.

Self-paying patients can now obtain semaglutide at a lower cost through trusted telehealth providers.

Approximately 1 million Aetna members will need new coverage with the announcement that CVS will be leaving the Affordable Care Act (ACA) individual exchange business next year.

Experts urge for technology-driven, collaborative solutions as patients shoulder a growing burden of prescription costs.

New treatments for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) enhance patient care with gene therapies and new mechanisms of action on the horizon, explained Casey Koch, PharmD, from Select Health.

Early actions by the new administration signal major changes in health policy, taxes, and pharmaceutical pricing.

Medicaid beneficiaries face higher rates of pulmonary hypertension, with significant economic burdens and racial disparities in prevalence and costs.

Expanding Medicare coverage for glucagon-like peptide 1 (GLP-1) receptor agonists could significantly reduce obesity-related health issues, but it also risks adding tens of billions in new costs, highlighting the need for smart policy strategies to ensure access, affordability, and long-term sustainability.

Asembia's AXS25 Summit will unite more than 8000 key decision-makers to explore pharmacy innovation, artificial intelligence, policy, and patient care from April 27 to May 1 at Wynn & Encore in Las Vegas, Nevada.

Richard Hughes IV, JD, MPH, spoke about the upcoming oral arguments to be presented to the Supreme Court regarding the Braidwood case, which would determine how preventive services are guaranteed insurance coverage.

Sam Peasah, PhD, MBA, RPh, director of High-Value Health Care Value-Based Pharmacy Initiatives at UPMC Health Plan, discusses ways that health plans can help reduce the cost burden of medications to improve adherence.