Payers

Closed-loop social care networks move beyond referrals, proving statewide scale can cut ED use and Medicaid costs while tracking real outcomes.

Anti-VEGF has maxed out in diabetic macular edema (DME), but Ang-2 and Wnt pathway approaches could target disease differently, said John Kitchens, MD.

CMS proposes major Medicare reforms to ACOs, physician pay, and MIPS reporting, aiming to reward outcomes over service volume by 2029.

New data suggest epcoritamab plus R2 may win insurer coverage, delivering major QALY gains at approximately $68,000 and delaying costly progression.

A proposed 2027 CMS rule would cut 340B Drug Pricing Program payments to curb Medicare drug costs and shift savings to patients.

emtelligent turns unstructured data into coded clinical insights, powering payer and oncology workflows to improve trial screening, EHR-to-EDC transfer, and decisions.

At ESMO GI, Merck’s next-generation KRAS-inhibitor calderasib plus EGFR-targeting cetuximab and chemotherapy produce remarkable progression-free survival results for patients with previously untreated colorectal cancer.

Community Oncology Alliance AI Playbook powers digital health practice transformation, guiding teams to choose AI partners, protect data, and expand efficient care.

Summary of Nonconsensus Discussions: Bridging the Gaps in Health Equity & Access in Multiple Myeloma | May 2, 2026, Tampa, Florida

Insurance and socioeconomic factors delay optimal anti-VEGF care for diabetic macular edema, worsening vision disparities.

Clinicians and pharmacists at Temple and Penn discuss barriers to multidisciplinary obesity care, from ICD-10 coding gaps to prior authorization burdens.

SEER and Medicare data project rising DLBCL and MCL cases through 2032, intensifying payer strain and demand for Brukinsa, Calquence, and CAR-T access.

With an FDA approval for its companion diagnostic in bladder cancer, Natera extends its Treatment on MRD strategy, deferring adjuvant immunotherapy for patients with negative results for disease following surgery.

Although smaller studies have highlighted CAR T differences in access and outcomes, new research shows the full extent of the issue.

Nancy Lin, MD, explores MMAI validation needs, turnaround advantages, equity implications, and how payers should approach AI-based diagnostics.

Nancy Lin, MD, explains how an AI model compares with genomic classifiers in HR+/HER2- early breast cancer, with implications for cost and access.

Covering delgocitinib for chronic hand eczema could save a 1M-member plan $88M over 3 years, driven by lower drug costs than off-label therapies.

Coverage denials delay care, drive patients into debt, and erode trust in insurers—yet nearly half of affected patients never appeal.

The authors describe Medicare Advantage plans that screen for and provide supplemental benefits addressing social needs and explore how these benefits meet communities’ social needs.

Community oncology practices face major infrastructure and reimbursement gaps when delivering bispecific antibodies.

Medicare’s GLP-1 Bridge offers temporary coverage for obesity medication at $50/month, but patients face a 2027 cliff as BALANCE stalls.

Accountable care offers one of the most promising frameworks for stabilizing and expanding access, but only if policy is intentionally designed to support rural participation.

A reproducible Prior Authorization Friction Index enables payers to identify glucagon-like peptide-1 delays and rework, reduce avoidable barriers, and monitor utilization, budgets, and equity in real-world practice.

An Institute for Value-Based Medicine® event in Princeton highlights how the state's leading cancer care providers meet the needs of a diverse population.

Beneficiaries in socially vulnerable communities received higher-quality, more-efficient care under value-based care (at-risk Medicare Advantage) compared with those in fee-for-service Medicare payment arrangements.