AMCP Nexus

AI revolutionizes member health risk identification, outperforming traditional models by integrating diverse data for proactive care in managed care settings.

Cardiovascular, Renal and Metabolic Conditions Increasingly Prevalent, Expensive for Medicare Fee-For-Service Population

'It just knows black or white; it does not know the gray in between...humans have to fill that gray in between.'

Bispecific T-cell engagers demonstrate lower total costs and reduced cytokine release and neurotoxicity rates compared with CAR T therapy for patients with follicular lymphoma.

Payers and providers are using real-world data to identify high-performing treatment centers, reduce administrative bottlenecks, and support value-based contracting arrangements.

New data reveals a rising trend in generalized anxiety disorder (GAD) prevalence among U.S. adults, emphasizing the need for improved diagnosis and treatment.

An abstract presented at AMCP Nexus 2025 showed that Medicaid drug spend in 10 states in FY 2023 was approximately equal to or less than the national drug spending rate of 14%.

Former House Speaker Paul Ryan called for evidence-based reforms, risk pools and premium support models for Medicare, to fix the nation’s strained healthcare system.

Panelists at AMCP’s policy summit debated PBM reform, disagreeing on spread pricing ethics and rebate transparency while discussing costs, risks, and whether current contracting models benefit patients.

A study at AMCP Nexus 2025 reveals how drug rebates and net prices influence insurance coverage for specialty drugs, impacting patient access.

An abstract presented at AMCP Nexus 2025 showed the overuse of opioids following successful cancer treatment is detrimental to patient health and expensive.

There is a need for strict policies regarding the use of AI in the managed care space, according to Douglas S. Burgoyne, Pharm.D., MBA, FAMCP, adjunct associate professor at the University of Utah College of Pharmacy.

Health plans and PBMs are using AI to aggregate data, summarize information and enhance their formulary decision-making processes, according to Douglas S. Burgoyne, Pharm.D., MBA, FAMCP, adjunct associate professor at the University of Utah College of Pharmacy.

Technology can help address the complexities of specialty medications by automating processes and enabling proactive interventions to ensure patients stay on their critical therapies, according to Kristen Whelchel, Pharm.D., CSP, Research and Patient Care Improvement Pharmacist with Vanderbilt Specialty Pharmacy's Department of Health Outcomes and Research.

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

Only 15% of those who start a glucagon-like peptide 1 (GLP-1) for weight loss are still taking it two years later according to Prime Therapeutics’ real-world evidence, says Ben Urick, Pharm.D., Ph.D., a health outcomes researcher for the pharmacy benefit manager.

Kristen Whelchel, Pharm.D., CSP, Research and Patient Care Improvement Pharmacist with Vanderbilt Specialty Pharmacy's Department of Health Outcomes and Research, explains how technology identifies at-risk patients, coordinates medication refills and more.

The FDA has already made more than a dozen cancer drug approval decisions this year and more expected in the next several months and in early 2025, according to Kaelyn Boss, who gave an oncology drug pipeline talk at the 2024 AMCP Nexus meeting this week.

Large PBMs are removing Humira from some of their formularies. AMCP Nexus panelists still see challenges and a need for education and more attention to patient interests.

Crescent Moore, Ph.D., Pharm.D., Director of Part D/Pharmacy at BluePeak Advisors, highlights the expected shift of Medicare beneficiaries towards Medicare Advantage Prescription Drug (MA-PD) plans.

Crescent Moore, Ph.D., Pharm.D., Director of Part D/Pharmacy at BluePeak Advisors, explains the impacts of the upcoming changes to Medicare Part D.

Charlie Dragovich, Senior Director and Client Strategist at Cencora, talks about the way regulations usually work and how the road to the Preapproval Information Exchange Act was different.

An overview of the preapproval information exchange (PIE) from Charlie Dragovich, Senior Director and Client Strategist at Cencora

Several companies are developing new drugs to treat transthyretin amyloidosis cardiomyopathy (ATTR-CM), a formerly obscure condition that is getting an increasing amount of attention.

How health plans are implementing strategies to leverage biosimilars to lower costs for both payers and patients, according to Javier Gonzalez, Pharm.D., chief growth and commercial officer of Abarca

Cynthiya Ruban, Ph.D., M.S., Director of Digital Solutions at Cencora says to keep the following in mind as AI use accelerates.

Ways AI is increasingly used in healthcare and how it can benefit healthcare decision makers, according to Cynthiya Ruban, Ph.D., M.S., Director of Digital Solutions at Cencora.

It's not the multimillion dollar prices, says Kevin Niehoff, Pharm.D., of IPD Analytics. The pool of sickle cell disease patients who are prime candidates for sickle cell disease gene therapy was overestimated, according to Niehoff.

Only a small group of patients have started the process to receive the new gene therapies for sickle cell disease, says Kevin Niehoff, Pharm.D., of IPD Analytics.