Policy

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 December issue features a conversation with AJMC Co–Editors in Chief A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design and a professor at the University of Michigan in Ann Arbor; and Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and the director of the Healthcare Markets and Regulation Lab at Harvard Medical School in Boston, Massachusetts.

McKesson's report highlights key trends in community oncology, emphasizing patient-centered care, precision medicine, and the need for innovative clinical trials.

Within the same physician groups, 2-sided risk in Medicare Advantage (MA) was associated with higher quality and lower utilization for dually eligible beneficiaries compared with fee-for-service MA and traditional Medicare.

The expansion of direct-to-consumer (DTC) pharmaceutical manufacturer models and the upcoming TrumpRx launch offer lower costs but create new complexities for patients.

With ACA subsidies and key CMS payment models ending in 2025, premiums are set to rise, shifting costs to consumers and employers.

Svetlana Barbarash, MD, outlines the lack of cardiologists and transplant services in Las Vegas and the policy changes needed to close gender gaps in care.

A large cohort study found adolescents and young adults starting TMP-SMX faced a higher 30-day risk of acute respiratory failure than those on other antibiotics.

Immune-boosting herbs were linked to lower autoantibody rates in patients before dermatomyositis onset, suggesting activation of alternative immune pathways.

Lower-income countries rarely gain timely access to FDA-approved drugs tested in their populations, highlighting major global and ethical disparities.

Targeted financing, clinician recruitment, and telehealth expansion are needed to improve rural primary care.

Infectious disease was hit hardest by funding cuts to NIH grant for clinical trials that did not align with the Trump administration's priorities.

Cuts to Medicaid could spell trouble for pediatric health, as millions of children rely on Medicaid to cover their hospital expenses.

One in 5 of the highest-revenue drugs of 2022 was exclusively approved for rare conditions, accounting for more than 7% of US pharmaceutical spending.

Experts say proposed pharmaceutical tariffs could raise drug prices, impacting patient access and health care budgets.

One-third of F32 grant recipients secure follow-up NIH K awards, fueling new biomedical discoveries and career growth.

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 November issue features a conversation with Laurie C. Zephyrin, MD, MPH, MBA, senior vice president for achieving equitable outcomes at the Commonwealth Fund. This interview has been edited for length and clarity.

HHS has initiated removal of black box warnings on hormone replacement therapy, citing its advantages to women's health, but also drawing pushback.

In this investigation, the authors evaluated the impact of a voluntary transition to risk-based contracts under Medicare Advantage on health care use.

Medicare Advantage plans that place greater restrictions on home health agency care delivery may have more adverse patient outcomes than plans that provide episodic payments.

Experts analyze how Trump's drug pricing policies, including Most Favored Nation (MFN) and tariffs, reshape pharma markets and impact patient costs and access.

Experts discuss personalized myasthenia gravis treatment, emphasizing patient education and engagement for optimal care and advocacy in managing this variable disease.

PBM legislation is rising nationwide, which experts emphasize could increase costs and hinder patient care.

Changing the FDA biosimilar interchangeability standards is a necessary but likely insufficient step to improve biosimilar competition in the US.

Geni Tunstall, JD, discusses how pharmacy benefit manager reforms, Medicaid changes, and the MAHA initiative may impact managed care pharmacy operations.

The FDA announced draft guidance to remove clinical efficacy studies for biosimilars and also issued the position that all biosimilars in the US should be interchangeable.