Policy

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

During the unwinding of continuous Medicaid provisions, 8.7% of pediatric patients at community-based health organizations became uninsured, with higher rates among older children, females, and those with chronic medical conditions.

Access and affordability are among the top priorities in health care for Americans who participated in the survey.

Abandoning efforts to reform payment for cell and gene therapies for Medicaid beneficiaries could allow ongoing access barriers to persist, said Adam Colborn, JD, of AMCP.

This study examines the impact of geographically limited disasters on health care quality performance scores of Medicare Advantage contracts, finding limited impact on performance scores.

World Cancer Day also marks the start of the ‘United by Unique’ campaign, which seeks to highlight how each person’s journey with cancer is unique, even though the patients, caregivers, and health care teams who are touched by cancer are united by shared goals.

With a majority vote by the Senate Finance Committee, Robert F. Kennedy Jr's nomination for health secretary is pushed to a vote from the full Senate.

The Comprehensive Care for Joint Replacement Model mitigated a trend of lower home health uptake for Black and White patients but not for other populations.

This week, Robert F. Kennedy Jr sat before the Senate for 2 separate hearings, to decide the fate of his confirmation as secretary of HHS.

A looming Supreme Court ruling will answer questions about the legality of the Affordable Care Act mandate for providing some preventive care services at no cost.

Adam Colborn, JD, of AMCP, discusses the complexities of drug pricing and what policymakers must consider in efforts to reduce prices and increase access.

Adam Colborn, JD, of AMCP, discussed how President Trump's rescission of several Biden-era executive orders may impact Medicaid and Medicare initiatives.

Sen. Bill Cassidy, MD, (R, Louisiana) holds a key vote on Robert F. Kennedy Jr's HHS Secretary confirmation. When Cassidy asked for a strategy on Medicare and Medicaid, Kennedy could not provide one.

The high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.

President Donald Trump's initial executive orders target previous efforts to reduce health care costs, pandemic preparedness, and international partnerships, showing a stark contrast to the Biden administration.

Experts suggest that most Americans will not experience immediate changes in their out-of-pocket health care expenses.

Attorneys General from several districts have come together in a lawsuit seeking damages from Walgreens for allegedly knowingly filling opioid prescriptions that lacked a genuine medical purpose.

Insurer-pharmacy benefit manager (PBM) firms control most of the Medicare Part D market, steering patients to their pharmacies through network exclusions and targeted marketing.

Semaglutide (Ozempic) is 1 of 15 medications that will be included in yearly price negotiations between Medicare and manufacturers.

Despite the availability of several noninvasive tests for colorectal cancer, prioritizing blood-based tests may result in higher costs and worse population-level outcomes.

The FDA cites cancer risk and the Delaney Clause in its decision to revoke food and drug uses of the dye.

There is limited awareness and utilization of supplemental benefits among Medicare Advantage beneficiaries, with cost-sharing and out-of-pocket spending playing key roles, a new study has found.

The increased urgency for vasectomy follow-through among men post-Dobbs aligns with previous administrative data indicating a rise in vasectomy procedure volumes after the decision.

The authors used medical loss ratio forms to assess trends in premiums, medical claims, administrative costs, quality improvement, and margins in the large group insurer market.

Cochair of our recent Institute for Value-Based Medicine® event hosted with NYU Langone Health, Oscar B. Lahoud, MD, speaks on his hoped-for top health care priorities under the incoming administration.

Check out this year's top coverage from The Academy of Managed Care Pharmacy (AMCP) Nexus 2024 meeting, which included relevant topics in health care policy, novel pharmaceutical developments, financial considerations across multiple conditions, and more.

The top 5 podcasts for 2024 cover Medicare Advantage prior authorization, health equity, global immunization challenges, trauma-informed care, and health literacy.

The health care provisions include key reforms targeting pharmacy benefit managers, extensions of Medicare telehealth flexibilities, and measures aimed at combating the opioid crisis and preparing for future pandemics.

A recent Federal Order from the US Department of Agriculture aims to track, prevent, and address contaminated dairy products while public health risk remains low.

Since its founding in 2012, the National Association of ACOs has evolved from a group of 30 to 477 accountable care organization members covering 9.2 million beneficiary lives.