May 5th 2025
To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes reflections from a thought leader on what has changed over the past 3 decades and what’s next for managed care. The May issue features a conversation with John Michael O’Brien, PharmD, MPH, a member of AJMC’s editorial board and the president and CEO of the National Pharmaceutical Council. This interview has been lightly edited for clarity.
How the IRA May Shift Economic Incentives for Drug Manufacturers: Dr Julie Patterson
May 8th 2024The Inflation Reduction Act (IRA) has potential to shift incentives for drug manufacturers and impact the amount of long-term evidence generated for approved drugs, said Julie Patterson, PharmD, PhD, senior director of research at the National Pharmaceutical Council.
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CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
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Traditional Medicare Supplemental Insurance and the Rise of Medicare Advantage
May 7th 2024Rising Medicare Advantage enrollment occurred alongside declines in enrollment in traditional Medicare with employer-sponsored supplemental coverage and traditional Medicare without supplemental coverage.
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Dr Seth Berkowitz on Whole-Person Health Indexes, the "Wrong Pocket" Problem
May 6th 2024Seth Berkowitz, MD, MPH, associate professor of medicine, University of North Carolina at Chapel Hill, discussed the challenges associated with developing a whole-person health index and potential solutions for the "wrong pocket" problem.
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The Senate Finance Committee has introduced bipartisan legislation that proposes using Medicaid and Medicare programs to help prevent and reduce generic drug shortages; US indicators for COVID-19, flu, and respiratory syncytial virus (RSV) declined further last week; findings from a recent study reveal growing disparities in child death rates across racial and ethnic groups.
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A new federal rule will enable thousands of immigrants in the Deferred Action for Childhood Arrivals (DACA) program to obtain health care through the Affordable Care Act; a forthcoming CMS rule is expected to lower home-based care wait times and raise caregiver wages; the HHS Office for Civil Rights has finalized 2 rules that strengthen the ACA’s health care discrimination ban.
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The Federal Trade Commission (FTC) issued letters to 10 companies to warn them that certain drug patents were improperly listed; the US Department of Agriculture (USDA) will begin testing ground beef for bird flu particles; rural Americans are more likely to die early from 1 of the 5 leading causes of death than those who live in urban areas.
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USPSTF Lowers Age for Biennial Mammograms to 40, Citing Early Detection Benefit
April 30th 2024The USPSTF lowered the recommended starting age for mammograms from 50 to 40 years, citing moderate benefits for early detection in this age group. Disparities persist, especially for Black women, highlighting the need for improved access to health care and social support.
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Medicaid, Medicare Policy Changes Could Lead to More Than 25,000 Additional Deaths, Study Says
April 30th 2024Researchers also estimated that more than 700,000 Americans with diabetes could lose insurance coverage if these proposed retractions are put into place, with some new policies already in effect.
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Makers of medical tests will have about 4 years to show the FDA that their new offerings deliver accurate results; after previously decreasing for 27 years, US tuberculosis (TB) cases increased every year since 2020; a US district judge rejected a challenge by Bristol Myers Squibb and Johnson & Johnson to the Medicare drug price negotiation program.
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Just as it is important for retail analysts to understand the choices their customers make and why they may choose not to purchase a specific item, so is it important for the specialty pharmacy industry to understand the actions of prescribers and how the often inefficient prior authorization process affects patient outcomes.
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CMS' 340B Repayment Proposal May Harm Vulnerable Hospitals, Reward Those With Higher Revenues
April 26th 2024The 340B hospitals not receiving an offsetting lump-sum payment from CMS following 2018-2022 cuts later ruled unlawful are disproportionately rural, publicly owned, and nonacademic, according to a new study.
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Examining the IRA’s Impacts and the Differences of a Second Biden vs Trump Term at AXS24
April 26th 2024During their session at Asembia’s AXS24, Sarah Butler and Lindsay Greenleaf of ADVI Health will examine the current status of the Inflation Reduction Act (IRA) and future considerations in health care in the context of the upcoming presidential election.
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How Potential Unintended Impacts of the IRA May Affect Patients: Dr Julie Patterson
April 24th 2024Julie Patterson, PharmD, PhD, senior director of research at the National Pharmaceutical Council, spoke to the ways in which possible unintended effects of the Inflation Reduction Act of 2022 (IRA) could impact patients.
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The Federal Trade Commission's (FTC's) vote to ban most employers from issuing and enforcing noncompete clauses could have varying impacts on the health care workforce; federal regulators vastly under-enforced antitrust laws in the hospital sector during the last 2 decades, resulting in increased health costs; the FDA recently found genetic evidence of the H5N1 bird flu virus in pasteurized commercially purchased milk.
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