Medicare

Cost and access, not side effects, drive GLP-1 discontinuation, and obesity should be covered like diabetes, says Fatima Cody Stanford, MD.

KFF finds 4.3 million Medicare beneficiaries will lose their MA or stand-alone Part D plans at the end of 2026 as PDP options keep shrinking.

Medicare’s GLP-1 Bridge program aims to expand obesity treatment, but eligibility hurdles and drug costs leave many seniors paying hundreds monthly.

Siva Mohan, MD, explains how drug costs drive silent nonadherence, PA burden, and biosimilar hesitancy, and what payers can do about it.

New non-CF bronchiectasis in Medicare is tied to high health care use and $8998 PPPM FFS spending; prevalence is highest in older women.

Medicare drug price negotiations lowered out-of-pocket costs for some beneficiaries, but those reaching the annual Part D cap saw no direct savings.

Medicaid expansion was associated with lower colorectal cancer mortality, with the largest reductions in Hispanic patients and stage IV disease.

The trade group says CMS lacks authority to impose GLOBE, which is set to begin January 1.

A legal fight over a single amino acid could set retatrutide's exclusivity window, its Medicare negotiation clock, and its competitive future.

Panelists ask whether cancer care will shift toward home-administered infusions as payers push for change. Other topics in this forward-looking session include new delivery tech and practice-led solutions.

A traditional Medicare out-of-pocket (OOP) cap could reduce beneficiaries’ costs but increase annual federal spending by $39 billion to $96 billion.

MA-to-MA switching among dually eligible beneficiaries rose sharply from 2016 to 2022, AJMC study author Grace Mackleby, PhD, found.

CMS finalized the mandatory GLOBE Model, tying Part B drug rebates to international prices in areas covering 25% of beneficiaries from Jan. 1, 2027.

AASM urges CMS to reject proposed 2027 Medicare conversion factor cuts of 1.19% to 1.68% and revise sleep testing and remote monitoring policies.

Sustainable models require asking what a result shows, what design produced it, and whether the design was built to measure value or just produce a number.

Average stand-alone Part D premiums are projected to rise by less than $1 a month as a temporary subsidy program ends after 2026.

Panelists say drug price negotiation, Medicaid changes, prior authorization, and 340B reform strain community oncology.

The NPS index, ranging from –100 to +100, serves as a proxy for customers’ willingness to recommend products and services they themselves have used.

The IRA's Medicare out-of-pocket cap is easing costs for patients with cancer, but community oncology leaders warn price cuts are straining practices.

Biomarker testing, referrals, screening, treatment access, and clinical trial barriers were examined during this recent IVBM.

Measles cases hit a year high. Here's what payers need to know about outbreak costs, MMR coverage, and plans to split the vaccine

Topical ruxolitinib prescribing in Medicare Part D surged through 2024, but its cost per day runs 16 times higher than generic tacrolimus.

Community oncology leaders urge 340B overhaul so drug discounts follow vulnerable cancer patients, with audits, transparency, and tighter contract-pharmacy rules. This commentary will be featured on the Cover of the October issue of Evidence-Based Oncology.

Reference countries have limited room to simply raise their own drug budgets to absorb the pressure, the lead study author explains.

Experts discuss what SCAN Health Plan's new Medicare Advantage (MA) partnership with Costco could mean for beneficiaries, competition, and costs.

CMS is funding 138 grants worth $144M to expand rural mental health, maternal, and emergency care access across Alabama.