Plans ramp up risk adjustment to serve legions of new members

Ty Gluckman, M.D., says missed lipid tests and clinical inertia, not prior authorization, are now the main barriers to reaching LDL goals.

Christine Johnston says biosimilar interchangeability bills, plus 2026 PBM reforms, would force PBMs to justify preferring higher-cost brands.

Phase 3 data fueled buzz about Moderna’s personalized melanoma “vaccine.” paired with Merck's Keytruda. The drama surrounding intismeran included an embargo violation and headlines that the treatment hadn't lived up to its hype.

Will Carroll, Pharm.D., of Sutter Health says future pharmacy leaders need business, finance and AI skills, and health systems need real sponsorship.

Will Carroll, Pharm.D., of Sutter Health says pharmacy is often handed strategy to execute instead of shaping it, and must show value in C-suite terms.

Ty Gluckman, M.D., says undertesting and undertreatment are the biggest gaps in lipid care and calls on leaders to invest in cardiovascular prevention.

Ty Gluckman, M.D., says the 2026 dyslipidemia guideline brings back risk-based LDL goals, and clinical inertia, not access, is now the biggest barrier.

Stanford Health Care’s Janjri Desai, Pharm.D., says pharmacists improve outcomes but often can’t bill for it, making billing parity key to growing services.