Policy

The federal government requires insurers to cover PrEP; Johnson & Johnson (J&J) and pharmaceutical wholesalers agree to settle opioid crisis lawsuits; NYC health care workers will be required to receive a vaccine or weekly tests for COVID-19.

Members covered by an integrated pharmacy benefit (as opposed to a pharmacy carve-out) experienced slower growth in medical spending.

With the delta variant now dominant in the United States, study results highlight the need for officials to do everything they can to increase vaccine uptake.

In this episode of Managed Care Cast, the lead author of an article in the July issue of The American Journal of Managed Care describes the latest research that looks at the power of self-insured employers to negotiate hospital prices and the relationship between employer market power and hospital prices.

Medicaid expansion was associated with a reduction in the racial disparity in timely treatment of patients with advanced cancer in the United States.

Larger primary care practices in downside risk–only payment models and capitation saw the highest telemedicine utilization rates by their patients enrolled in Medicare Advantage (MA) plans.

An advisory from the US Surgeon General classifies COVID-19 misinformation as a public health threat; the most populous county in the nation reinstates a mask mandate; debate continues around COVID-19 booster shots.

A string of controversies surrounding the approval of Biogen's Alzheimer disease drug aducanumab (Aduhelm) has not only called into question the independent nature of the FDA, but puts both providers and patients in a challenging position when it comes to deciding whether or not to prescribe or take the treatment.

The new standards come as community oncology practices await word on the future of the oncology care model, which will expire in 2022.

On this episode of Managed Care Cast, Charlie Wray, DO, MS, an assistant professor of medicine at the University of California San Francisco, outlines the findings of a paper he coauthored which assessed Americans' experiences with their insurance providers.

Medicare Advantage plans may deliver care more efficiently to food-insecure beneficiaries than traditional Medicare, but they are not better at reducing food insecurity.

PBMs keep copays higher on the same generic drugs.

Pfizer and BioNTech said they will seek approval for a booster shot of their COVID-19 mRNA vaccine, while US health authorities said a booster is not necessary. In addition, the CDC emphasized in-person learning for schools this fall in updated guidance.

President Joe Biden is expected to sign an executive order aimed at lowering drug prices; the FDA imposes limits on who should receive a controversial new Alzheimer disease drug; western US states prepare for a second heat wave.

New data underscore how obesity, racial disparities and recent treatment advancements have impacted cancer mortality and incidence rates.

The FDA issued a Complete Response Letter, halting Provention Bio's type 1 diabetes prevention drug.

Abstracts cover the cost of cancer-related diarrhea, 30-day readmission rates, and how perceptions of the likelihood of survival affect end-of-life care.

The proposed changes to the payment model for end stage renal disease (ESRD) would make it the first payment model under the CMS Innovation Center to directly address health equity by incentivizing increased rates of home dialysis and kidney transplants.

The measure is designed to end surprise medical billing and balance billing, taking the first step to implement the so-called No Surprises Act that passed Congress at the end of last year.

A heat wave affecting the Pacific Northwest region of the United States and parts of Canada is linked with hundreds of deaths; Arkansas sees a rise in COVID-19 cases; updates to federal funeral assistance program.

To mark National Gun Violence Awareness Month, The American Journal of Managed Care® assessed how events in 2020 shaped the United States' gun violence epidemic.

At a session of AHIP 2021 Institute and Expo Online, the head of North Carolina's health and human services department and a health equity policy advisor in the Biden administration discussed how collecting and using data to achieve health equity is ultimately a policy decision.

Michael D. Anestis, PhD, executive director of the New Jersey Gun Violence Research Center and associate professor at the Rutgers School of Public Health, discusses his research on firearm ownership and suicide, in addition to steps needed to help decrease rates of gun-inflicted suicide and gun violence in general.

Only 60% of hospitals display their cash prices and 5% display their minimum negotiated charges on their public websites; many hospitals are in violation of new federal legislation.

The Biden administration has promised to invest billions in antiviral medicine development; certain hospitals associated with Black patients' COVID-19 mortality rates; increased rates of medicaid enrollment.

The Medicare Payment Advisory Commission (MedPAC) suggested several changes to Medicare Advantage (MA) plan benchmark calculations, with the intent to generate yield savings for Medicare, and urged CMS to streamline alternative payment model (APMs) where it can.

In a 7 to 2 decision, the Supreme Court ruled Thursday that the Affordable Care Act (ACA) will stand, as plaintiffs seeking to declare the law unconstitutional did not have standing.

Mean in-network commercial allowed amounts and charges per anesthesia conversion factor are 314% and 659% of traditional Medicare rates, respectively. Medicare Advantage payments align with traditional Medicare prices.

On this episode of Managed Care Cast, we speak with the author of the annual PwC Behind the Numbers report, which looks ahead at medical cost trends in the United States.

The No Surprises Act represents a rare bipartisan moment for Congress and a long-needed safeguard for patients that will reorient relationships among payers and providers.