Expert Interviews

Hispanic HIV incidence rose 16.8% in antisanctuary counties after the 2018 public charge announcement, relative to baseline counties, a new study found.

ProAct Chief Operating Offier Deborah Dempsey says plan sponsors still lack the data and visibility to know whether they were shorted on a 340B claim.

OrionRx's Don Anderson, Pharm.D., says a GLP-1 access model built around mandatory wellness coaching resulted in a six-point drop in body mass index and improved mental health.

Poh says there is no single algorithm that applies to the treatment for patients with relapse or refractory follicular lymphoma.

More treatment doesn't automatically mean better treatment, Poh stresses, and the combinations that can improve progression-free survival come with the risks of additional toxicity and treatment complexity.

ProAct's Deborah Dempsey, Pharm.D., MBA, RPh, explains how 340B discounts to healthcare entities are in conflict with rebates that manufacturers pay to health plan sponsors.

Optum Rx's Anne Mall, M.H.A., says her company's AI is surfacing clinical details buried in providers' chart notes so clinicians can decide on therapy faster.

Optum Rx's PreCheck Prior Authorization tool automates 64% of approvals in under 30 seconds, getting patients onto therapy four days faster, Anne Mall, MHA, says.

OrionRx's Don Anderson, Pharm.D., outlines near-term and long-term fixes for the blind spots created when members buy medications outside their pharmacy benefit.

OrionRx's Don Anderson, Pharm.D., says drugs filled outside a member’s pharmacy benefit could result in excessive and duplicative prescriptions.

As PBMs plan for 2028 rollout of the PBM transparency provisions of the Consolidated Appropriations Act of 2026 (CAA 2026) cost-plus pricing will flip how drug costs look on paper, requiring far more data, says Milliman principal Kessler.

Kessler, a principal at Milliman, says employers need to pay attention to their claims and pharmacy benefit contracts.

The president of Vivid Clear Rx says PBMs should limit point solutions early on and warned against farming out too many services to vendors that a PBM should provide itself.

Yes, breaking up is hard to do, acknowledged the president of Vivid Clear Rx. But employers should be "brave" about severing their ties to one of the “big three” pharmacy benefit managers (PBMs) and contracting with mid-size PBMs like hers, says Amy Wadstrom, RPh.

A principal and product owner at Milliman, Kessler discusses some of the reasons for heightened attention and scrutiny of plan sponsor fiduciary responsibility when it comes to pharmacy benefits.

The president of Vivid Clear Rx says finding a GPO partner whose goals align with a PBM's moves transparency forward for clients.

The president of Vivid Clear Rx says meaningful PBM transparency means pairing access to data with help from an educational partner.

Preschoolers who are constantly "on the go" or interrupt others are up to six times more likely to receive an ADHD diagnosis, new national data show.

The dosing schedules for both tafasitamab and epcoritamab in combination with rituximab and lenalidomide are quite intensive initially, Poh says, but become less intensive over time.

In the relapse or refractory setting, there is growing interest in adding immune-based therapies such as tafasitamab and epcoritamab to the established combination of rituximab plus lenalidomide, says Poh.

In this closing segment of the Managed Healthcare Executive Between the Lines series, Philip Mease, MD, of Swedish Medical Center, Providence St. Joseph Health, and the University of Washington, and Saakshi Khattri, MD, of the Icahn School of Medicine at Mount Sinai, wrap up their discussion of the BE BOLD trial with a look at its relevance to payers and how the data should inform treatment decisions going forward.

Luis Ortiz, M.D., of Johns Hopkins All Children's Hospital, explains the subtle signs of childhood narcolepsy that parents often overlook.

Efficacy is obviously important, Poh says, but so is finding the right balance of toxicity, convenience and value for patients.

Fevers, drenching night sweats, weight loss, significant or progressive lymphadenopathy, involvement of the bone marrow that is significant that leads to cytopenias, or if the disease is threatening the function of an important organ are among the reasons to start treatment, says Poh.

Continuing the Managed Healthcare Executive Between the Lines series, Philip Mease, MD, of Swedish Medical Center, Providence St. Joseph Health, and the University of Washington, asks Saakshi Khattri, MD, of the Icahn School of Medicine at Mount Sinai, to reflect on her real-world experience with bimekizumab's safety profile and the broader clinical takeaways from the BE BOLD trial.

People may not be fully aware of added cost exposures if they shift to bronze Affordable Care (ACA) plans, says Margaret A. Murray, M.P.A., CEO of the Association for Community Health Plans. Murray says the nonnetwork plans that the Trump administration is promoting will result in underinsurance.

Margaret A. Murray, M.P.A., CEO of the Association for Community Affiliated Plans, says outreach and texting will be key to keeping eligible Medicaid enrollees covered under new redetermination and work requirements.

Margaret A. Murray, M.P.A., CEO of the Association for Community Affiliated Plans, says ACAP opposes Medicaid work requirements but seeks common ground with CMS on issues such as program integrity.

Understand diagnosis, watchful waiting, and long-term risks in slow-growing lymphoma—monitoring symptoms, relapse, and transformation.

Learn how follicular lymphoma often appears later in life, shows subtle symptoms, and follows a relapsing course with remission cycles and transformation risk.