Insurance

Early modeling put sickle cell gene therapy coverage near 11 cents per member per month.

Claims data show evidence of HIV virus in 5 of 2913 long-acting cabotegravir users and higher adherence vs oral therapy.

Experts at AMCP Nexus say biosimilar launches should prompt payers to revisit step therapy and measure value beyond market share.

Three experts apply policy, pharmacy operations, and member-level lenses to the same prescriptions to show why cost at the counter decides adherence.

Most Medicaid unwinding losses were procedural. mPulse's SriVani Ganti explains how plans can keep eligible members.

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.

Speakers at ASN Kidney Week urge nephrologists to appeal prior authorization denials, include children in trials, and expand access to glomerular disease therapies globally.

Nearly half of working-age adults were inadequately insured in 2026, and half went without needed care due to cost, a Commonwealth Fund survey found.

Birth centers are unavailable in 10 states, and 39% of birth center births are self-pay, as licensing and Medicaid pay limit access, a report finds.

In states that covered obesity-labeled GLP-1 RAs, total GLP-1 RA use rose less than obesity-labeled use alone, suggesting possible substitution.

HR 1 brings Medicaid work requirements and narrower immigrant eligibility by January 2027, and CBO projects 10 million more uninsured by 2034.

CMS ends ACA subsidies for 189,000 enrollees with duplicate Medicare, Medicaid, or CHIP coverage or listed as deceased, with a 30-day dispute window.

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.

CMS finalized Transparency in Coverage updates as a researcher warns ghost rates and missing inpatient data limit payer price files.

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.

New data on atopic dermatitis show treatment gaps, heavy reliance on dermatology APPs, and wide state variation in specialist supply

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

Aligning financial incentives with patient-centered care is becoming an increasingly complex path to navigate within oncology.

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

A new type of eye drug matched standard anti-VEGF therapy in a large trial for diabetic macular edema, a disease affecting 1.6 million Americans.

Debra Patt, MD, PhD, MBA, MPH, discusses how AI can streamline prior authorization and revenue cycle workflows in community oncology.

Payers say NCCN guideline concordance sets a baseline for cancer coverage, but cost and formulary variation may still limit access.

Irfana Lakada, PharmD, CSP, explains why onboarding may be the wrong time to screen for social needs and why rescreening matters.

Jesse Dresser explains how federal PBM reform, a new CMS RFI, and FTC settlements could reshape specialty pharmacy contracts and pay from 2027.

Accelerated approvals, surrogate end points, and high drug costs are reshaping cancer center formulary decisions, explained panelists at PCOC.

Most community oncology practices now administer bispecific antibodies in-office, but reimbursement gaps remain a top barrier, a survey finds.