Briana Contreras

Alli Oakes, executive director of research at Trilliant Health, shared that upcoding is a “prime example” of healthcare waste—where visits are billed at increasing levels of intensity without clinical justification.

New research published in the American Journal of Health-System Pharmacy suggests a possible link between the GLP-1 drug semaglutide and allodynia, a painful skin sensitivity.

A Republican-led bill aiming to tighten Medicaid eligibility and impose work requirements sparked heated protests and clashes amongst House parties, with critics warning it could leave millions without health coverage.

Witty was the top executive of the country's largest healthcare company during some of its darkest chapters, including the killing of the head of its health insurance business.

Their concerns come in response to the bill unveiled Sunday night by House Republicans that would tighten eligibility rules, create work requirements and freeze provider taxes under Medicaid—the federal-state program that insures nearly 80 million low-income Americans.

The House Energy and Commerce Committee has scheduled a public markup hearing for the Republican bill for tomorrow at 2 p.m.

A new survey by Johnson & Johnson revealed that oncologists are overwhelmed by the rapid pace of innovation in cancer care, with many calling for better tools, education and collaboration to help integrate new treatments and technologies into everyday practice.

In a conversation with Managed Healthcare Executive, 10XBeta CEO Marcel Botha warned that proposed Medicaid cuts, combined with federal budget reductions under the DOGE initiative, could exacerbate the rural healthcare crisis—threatening efforts to bring mobile, community-driven innovations to underserved areas.

A new JAMA Dermatology study found that once-daily Zoryve (roflumilast) foam, 0.3%, safely and effectively reduced scalp and body plaque psoriasis symptoms in patients 12 and older, offering a convenient, and more tolerated treatment option that may boost adherence and quality of life.

The latest report by Urban Institute warns that proposed Medicaid funding cuts could cost states like California, New York, Massachusetts and the District of Columbia hundreds of billions of dollars over the next decade.

A study found that while patients with atopic dermatitis often turn to social media for skincare advice, their decisions are most influenced by healthcare professionals, personal experience, and disease severity.

A new study by JAMA Health Forum found that universal annual depression screening for young adults during primary care visits is cost-effective and can result in greater benefits if paired with better treatment access and lower costs, particularly for multiracial and Hispanic females.

Treating hidradenitis suppurativa is complex and often requires taking a number of medications, including antibiotics, hormone therapies and immunosuppressants. However, many of these treatments are used off-label, and at this time, only two biologic therapies—Humira (adalimumab) and Cosentyx (secukinumab)— are approved by the FDA for HS treatment.

Becky Davis of Charles River Associates predicts that an influx of new and oral GLP-1 drugs, along with pricing pressures from policy and competition, will reshape the weight loss drug market in the next two years.

At the 2024 Asembia Specialty Pharmacy Summit, Becky Davis, principal at Charles River Associates, discussed how employer-based insurance coverage for GLP-1s remains uneven—and what factors are influencing decisions about access to these weight-loss treatments.

At this year’s Asembia Specialty Pharmacy Summit in Las Vegas, Managed Healthcare Executive spoke with John Beardsley, senior vice president of corporate business development at CoverMyMeds, and Fauzea Husain, vice president of public policy at McKesson, about what potentially lies ahead for the Inflation Reduction Act under this Trump administration.

At the 2025 Asembia Specialty Pharmacy Summit in Las Vegas, John Beardsley, senior vice president of corporate business development at CoverMyMeds, and Fauzea Husain, vice president of public policy at McKesson, discussed the future of Medicare drug pricing, including potential changes to the “pill penalty” and efforts to improve transparency in the negotiation process.

Kathi Henson, senior vice president of patient services, nursing and quality at Orsini, spoke with MHE editors at this year’s Asembia Specialty Pharmacy Summit in Las Vegas about how analytics and AI are shaping the future of specialty pharmacy. She highlighted the unique role data plays in improving patient outcomes, managing rising costs and maintaining high standards of care in an increasingly complex field.

Joe DePinto from McKesson discussed the challenges facing cell and gene therapies, particularly around reimbursement, and highlighted successful strategies to speed up access. He also shared optimism for the future, with many products already achieving blockbuster status and more expected by 2030.

Joe DePinto, MBA, head of cell, gene and advanced therapies at McKesson , met with MHE at the annual Asembia Specialty Pharmacy Summit in Las Vegas this week to give some insight on where we are with cell and gene therapies, as well as looking at Pfizer's discontinued hemophilia B gene therapy, Beqvez (fidanacogene elaparvovec-dzkt).

Shawn Griffin, M.D., president and CEO of URAC, shared his insights into best practices for promoting health equity during the annual Asembia Specialty Pharmacy Summit in Las Vegas today.

At this year’s Asembia conference in Las Vegas, Shawn Griffin, M.D., president and CEO of URAC, spoke about the need for strong leadership and community-based data in specialty pharmacies to identify and address health disparities, which will then improve care for all patients.

Managed Healthcare Executive asked several experts in healthcare and managed care to share the trends they think the industry is overlooking. From rising costs and data challenges to shifts in how care is delivered, these are the issues that could have a major impact — and deserve a closer look.

Experts at City of Hope, Simon Nazarian and Nasim Eftekhari, discussed the transformative potential of AI in cancer care.

Researchers of a new JAMA study said that without further participation in accountable care organizations, including the ACO REACH model, the program is unlikely to meet its goal of reducing health disparities.

In a recent conversation with Managed Healthcare Executive, Geoffrey Rutledge, M.D., of HealthTap, warned that the narrative around GLP-1 drugs is often oversimplified—and potentially harmful.

In 2024, top issues included daily work activities, work-life balance and conflict with managers. Now in 2025, those concerns have evolved into broader, more alarming themes: workplace stress, interpersonal conflict and performance issues.

In a recent discussion with Managed Healthcare Executive, three leading dermatologists and itch experts—Shawn Kwatra, M.D., Brian Kim, M.D., and Gil Yosipovitch, M.D.—shared where the science is going, what’s holding it back and how the healthcare system can better support patients.

Maureen Corcoran, director of the Ohio Department of Medicaid, believes the work requirement policy can be both a financial and moral effort to improve the lives of Medicaid consumers.

With policymakers considering work requirements for Medicaid eligibility, Jennifer Haley, principal research associate in the Health Policy Division at the Urban Institute, said it’s more important than ever to understand how those changes could unintentionally cause harm, particularly when data systems fall short and public awareness is limited.