Payers

During an afternoon AMCP 2026 session, experts called for integrated clinical and payer care models to combat rising metabolic disease prevalence, costs, and complexity.

Todd Doyle, MD, of OneOncology, warns that commercial payers lag on updating bundled codes, which has slashed radiation oncology revenue and risks community cancer access in 2026.

Prior authorization and PBM utilization management delay oncology and hematology novel therapies, shifting reimbursement risk to patients in Medicare Advantage.

Tim Church, MD, PhD, MPH, explains that access to care—not willpower—is the central barrier to GLP-1 use, and says employer coverage decisions are finally catching up.

A phase 1 clinical trial specialist, Nancy L. Lewis, MD, MBS, FACP, most recently spent more than a decade at Novartis and was previously a faculty member at Fox Chase Cancer Center and Thomas Jefferson University Hospital.

ACIP changes threaten vaccine coverage and raise costs, according to a roundtable of experts warning of widening disparities and long-term public health risks.

The law stems from the case of a beneficiary of the state workers health plan, repeatedly denied an alternative cancer treatment, only to be approved after he was too ill to be a candidate.

The study covers the period of 2015-2019 in Germany, before approvals for CAR T-cell therapy, pirtobrutinib, and the arrival of less toxic BTK inhibitors.

Rapid genetic test for IVF identifies FSHR variant in 60 minutes, guiding IVF hormone selection and improving in vitro fertilization success.

Real-world evidence shows Pluvicto matches pivotal trial benefits in PSMA-positive mCRPC, with longer PFS after an androgen receptor pathway inhibitor.

Genmab’s epcoritamab (Epkinly) streamlines bispecific antibody workflows for DLBCL and follicular lymphoma, cutting chair time, waste, and costs.

Scripta allows consumers to compare prescription prices, coupons, and insurance options in one place, helping patients and employers find affordable meds and smarter choices.

340B covered entities are expanding contracts with retail pharmacies that are increasingly located in counties with high rates of Medicare and Medicaid insurance coverage.

New GLP-1 pills challenge injections as competition, and discussions of possible Medicare coverage could push prices down.

Reform priorities aim to reshape PBM oversight, delink compensation from drug prices, boost transparency, and protect pharmacy access.

Ameet Patel, MD, concludes by outlining strategies to overcome operational, financial, and payer challenges in delivering advanced multiple myeloma therapies.

Catherine Gaffigan, MD, Elevance Health's President of Health Solutions, discusses value-based care initiatives and payer-provider relationships.

Penetration of Medicare Shared Savings Program accountable care organizations and Medicare Advantage was not associated with substantive changes in health care use among commercial enrollees.

Oral GLP-1 costs, insurance gaps, and formulary switches reshape drug pricing and access—learn how to navigate coverage.

Epcoritamab delivers lasting 3-year remissions in relapsed large B-cell lymphoma, with over half of complete responders staying progression-free.

New bipartisan legislation would ban parent companies from owning insurers or PBMs and providers or management services organizations simultaneously.

The visual nature of head and neck cancer calls for treatment strategies that will minimize toxicities related to radiation therapy. Advances in precision radiation techniques, supportive care, and multidisciplinary approaches have improved outcomes, improving quality of life.

A large commercial insurer is increasingly covering acupuncture, which is a safe and effective alternative to opioids, for multiple pain conditions.

This article highlights challenges in prior authorization and offers practical, experience-based strategies to streamline workflows, reduce delays, and improve patient access to necessary treatments.

Medicare Advantage enrollment has increased in the US and Puerto Rico, with a dramatic growth among Puerto Rico beneficiaries with end-stage renal disease.