Proponents say direct-to-consumer sales by drugmakers cut out intermediaries that add needlessly to prices. Detractors see ethical issues and prices that are still too high for many patients.

Employers, some lawmakers and others have criticized pharmacy benefit managers (PBMs), especially the "big three," for having complicated, sometimes hidden practices. The PBMs say they have responded with programs and policies that add transparency to what they do.

Datroway (datopotamab deruxtecan) is the first TROP2-directed therapy approved for advanced lung cancer in the U.S.

For payers, claims for rare disease treatments used to be uncommon. Not anymore, thanks to an increasing number of new, high-priced drugs for rare diseases.

According to the latest edition of The Cancer Atlas, lower-income nations are experiencing a rise in lung, colorectal and breast cancer incidence due to increasing adoption of behaviors associated with economic development—such as tobacco use, poor nutrition and physical inactivity.

Optum Rx officials said they now have eliminated reauthorization requirements for more than 140 chronic disease medications.

To prepare for CMS’ new risk adjustment data validation (RADV) strategy, Medicare Advantage plans must take a coordinated, organization-wide approach.

Patients addicted to opioids receive less mental health care if they are only covered by public insurance, compared with patients receiving care through alternate funding, according to a recent study published in Addiction Science & Clinical Practice.

Health plans must embrace real-time member awareness, timely clinical context and actionable insights to realize the benefits of care management.

Cuts to Medicaid have divided Republicans in the Senate

Here’s what you missed this week on Managed Healthcare Executive.

Employers are key to transforming healthcare by creating competitive, cost-effective networks independent of federal policy changes, according to Christoph Dankert, chief network officer of Carrum Health.

As sweeping policy shifts and rising restrictions threaten LGBTQ+ health access, providers, payers and employers reflect on what’s at stake in Pride Month's end—and what it will take to protect affirming equitable care for the future.

A separate Prime analysis, however, of year-over-year claims data for Wegovy and Zepbound only found an improvement in adherence in 2024, suggesting there is an evolving understanding of obesity treatment.

Of the 102,166 GLP-1s analyzed, 94% had some form of commercial insurance, yet cost-saving options were still widely overlooked.

Uninsured or self-pay obesity patients can get any dose of Wegovy for $299 from July 1–31, 2025. Patients can get their prescription filled through CenterWell Pharmacy, now associated with Novo Nordisk and WeightWatchers.

A new study finds that enrollees who had difficulty accessing care in Medicare Advantage plans were more likely to switch to traditional Medicare than to another MA plan.

Independent prescribing by health system pharmacists has decreased, but a survey shows greater involvement in emergency departments and an expanding role for pharmacy technicians.

Access to contraception is essential for reproductive health, yet women with disabilities face disproportionate obstacles.

This latest data is a change from previous survey answers, in which 71% of healthcare leaders expected improved profitability and 69% of leaders anticipated a rise in revenue in 2025, according to combined data from the Deloitte Center for Health Solutions.

Smart Communications surveyed 3,000 consumers worldwide to understand evolving expectations for digital customer experiences, especially in industries such as healthcare, insurance and financial services.