News

South Dakota voters rejected Amendment I, which could have ended Medicaid expansion for approximately 31,000 residents if federal funding fell below 90%.

Christine Johnston says Medicaid plans have embraced biosimilars faster than commercial plans and challenges the idea that more expensive means better.

After more than 20 years at Humana, Jeremy Gaskill now leads nonprofit Geisinger Health Plan. The problems are the same, he says, the scale for solving them differs.

Jeremy Gaskill took the reins at the Geisinger Health Plan earlier this year after a long career at Humana. He discusses the similarities and differences between Geisinger and Humana and the advantages of a health plan that is part of a health system.

The retail pharmacies will be in one company and Aetna and CVS Caremark, the PBM, in another, according to news reports.

Swedish registry study links parents’ autoimmune diseases to higher childhood type 1 diabetes risk, suggesting shared genetic susceptibility beyond pregnancy effects.

Christine Johnston warns a thin biosimilar pipeline keeps specialty costs high and slows innovation and urges payers to check their PBM’s top 25 drugs.

Speakers and researchers at this year's meeting in San Diego focused on drug pricing policy, getting savings to patients at the pharmacy counter and keeping people in charge of AI.

The generic twice-yearly HIV prevention shot is expected to cost $40 a year in 120 countries, 16 months after Gilead's original approval.

Findings from an analysis of IQVIA claims data show a prevalence rate that is five times lower than previous reports. Some of the discrepancy could be chalked up to the difference between using claims data instead of self-reporting by survey respondents.

In the MDT-BRIDGE trial, 92% of patients with stage II-III lung cancer reached surgery or chemoradiation after a midtreatment tumor board review.

Epic Research finds over half of children with type 1 diabetes miss autoantibody testing, risking misdiagnosis and limiting early treatment options like Tzield.

Higher MRI-measured liver disease activity was linked to lower quality of life and more anxiety and activity problems in 802 adults with suspected MASLD/MASH in Europe.

Teen boys with obesity and lower baseline fitness were less likely to see MASLD resolve during a lifestyle program, a Belgian study found.

MassHealth's Katelyn Meyer, Pharm.D., says mandatory coverage, young patients and an unpredictable FDA make planning for new specialty drugs a challenge.

A truly transparent PBM arrangement starts with full disclosure of direct and indirect compensation.

The rule requires pharmacy benefit managers to disclose rebates and discounts, money made from spread pricing and incentives for formulary placement.

As pulmonary fibrosis treatment options grow, Rachael Prusi of Prime Therapeutics says health plans should lean on guidelines and strong case management.

Patients with pulmonary fibrosis wait about two years for a diagnosis. Rachael Prusi of Prime Therapeutics explains how health plans can find them sooner.

The FDA has approved three HIV products since June 2025, and the late-stage pipeline is testing how far apart doses can be spaced. Here are the milestones payers and health systems should track through 2027.

Hiva Pourarsalan at AMCP Nexus explains how MFP shifts Medicare drug pricing, disrupting rebates and contracting and forcing payers to rethink formularies.

EHRs miss many cancer deaths. Linking electronic health records with claims and third‑party death data sharply improves accuracy, Tempus reports at AMCP Nexus.

CMS projects roughly 2.3 million people will lose Medicaid coverage in 2027 under the new community engagement requirements, also referred to as work requirements: four in ten to paperwork, not noncompliance. Arkansas showed how that happens; here is what plans can learn before the clock starts.

Managed care leaders should vet AI tools before use and recheck them over time, and pharmacists need AI literacy, according to two AMCP Nexus 2026 presenters.

AI is speeding up managed care pharmacy work, but two pharmacists say human review remains key when tools affect patients' access to medications.

A review of 16 studies linked presurgical melatonin and zolpidem to less postoperative pain, with over 30% less opioid use in some patients.

Prime Therapeutics' Pat Gleason, Pharm.D., outlined T1D screening gaps for plans and his priorities as incoming AMCP president.

Healthcare affordability has emerged as an issue in the Nov. 3 elections that will determine control of the Senate and the House.