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Milliman’s Jennifer Cruz says plans are losing rebates because of steep price discounts negotiated under the Inflation Reduction Act. but that they need to be sure that renegotiation of rebate guarantees doesn’t get too broad.

Pharmacy benefit managers are approaching health plans with value-based contracts that consider lower costs on the medical benefit of the insurance, says Jennifer Cruz of Milliman.

AI and virtual care revolutionize dermatology, enhancing melanoma detection, expanding patient access and improving efficiency in clinical practices.

New interim safety and efficacy data for primary biliary cholangitis (PBC) treatment Livdelzi (seladelpar) demonstrates sustained itch relief and the potential to slow disease progression.

The discounts will be for not-yet-approved formulations of Wegovy, Zepbound and Lilly’s oral GLP-1 orforglipron. Additionally, a pilot program starting in 2026 will provide for Medicare Part D coverage of these investigational anti-obesity medicines.

Drugmakers are scrambling to set up direct-to-consumer programs in response to President Donald Trump’s executive orders. Should pharmacy benefit managers be worried? Are the programs good for patients?

Meet the newest member of the Managed Healthcare Executive editorial advisory board.

Melissa Hanna, J.D., MBA, co-founder and CEO of Mahmee, was one of Managed Healthcare Executive’s 2021 Emerging Leaders in Healthcare. Four years later, she continues to lead the company as it expands payer partnerships and reaches more than 60 million covered lives — while embracing a new chapter of growth shaped by motherhood.

Can artificial intelligence reliably spot cancer risk earlier and more reliably than the human-based version?

Nearly all women experience a decrease in libido as they go through perimenopause and menopause, but it remains unaddressed

Fulton County leaders tackle healthcare disparities by forming partnerships and enhancing access, aiming for equitable health solutions in Georgia. Pamela Roshell, Ph.D., and LaTrina Foster spoke with Managed Healthcare Executive in this second part of a two-part video interview series.

Consistent moderate physical activity significantly reduces the risk of digestive system cancers, highlighting the importance of long-term exercise for prevention.

Fulton County, Georgia addresses health disparities through innovative partnerships, expanding access to care and a holistic approach to behavioral health services, according to county experts LaTrina Foster and Pamela Roshell, Ph.D., in this first part of a two-part video series.

Next-generation sequencing (NGS) holds great promise for identifying 'tumor-agnostic' therapies, but evidence does not support its routine use in clinical care and diagnosis of sarcoma, a consensus statement concludes.

Transitions of Care (TRC), Medication Reconciliation Post-Discharge (MRP), and Plan All-Cause Readmissions (PCR) are among the measures that have a major effect the Star Rating of health plans.

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

Although people are living longer with HIV, patients must still grapple with survivors’ remorse and the challenges of growing older within an ageist society.

Early childhood stressors, like divorce, could increase the risk of developing psoriasis later in life, highlighting the importance of emotional well-being, according to the results of a recent Swedish study.

A recent JAMA Pediatrics study revealed the enduring effectiveness of the HPV vaccine, highlighting its role in reducing cancer risk among young women.

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

Although dry eye disease (DED) affects millions of Americans, there is a lack of effective treatment options and discontinuation rates are high, according to an abstract presented at AMCP Nexus 2025.

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%.

Critics say it doesn’t address the misalignment and a shift from the major PBMs collecting fees instead of rebates.

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