AJMC (The American Journal of Managed Care)

AJMC (The American Journal of Managed Care)

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Managed care, payer policy, value-based care, and population health.

Weight Loss, Obesity Drugs Bring Potential New MASLD, MASH Treatment Strategies
NewsApr 16, 2026

Weight Loss, Obesity Drugs Bring Potential New MASLD, MASH Treatment Strategies

A new review in *Diabetes, Obesity and Metabolism* shows that GLP‑1, GIP and glucagon‑based drugs, originally approved for obesity and diabetes, also improve liver outcomes in metabolic dysfunction‑associated steatotic liver disease (MASLD) and its progressive form MASH. A recent meta‑analysis...

By AJMC (The American Journal of Managed Care)
Smarter Oncology Management Needed as Costs Continue to Climb
NewsApr 16, 2026

Smarter Oncology Management Needed as Costs Continue to Climb

At the AMCP 2026 meeting, experts warned that oncology has become the largest cost driver for health plans, with cancer drugs accounting for 50‑60% of total cancer spend. They highlighted that expanding FDA approvals, longer treatment courses, and combination regimens...

By AJMC (The American Journal of Managed Care)
Staging, ctDNA, and the Art of Personalizing Metastatic Breast Cancer Therapy: Hayley Knollman, MD
NewsApr 16, 2026

Staging, ctDNA, and the Art of Personalizing Metastatic Breast Cancer Therapy: Hayley Knollman, MD

Hayley M. Knollman, MD, highlighted how estrogen‑receptor‑positive metastatic breast cancer still relies on conventional staging—blood work, imaging, and tissue biopsies—while emerging HER2‑low categories gain relevance only after disease spreads. She noted that circulating tumor DNA (ctDNA) and broad genomic panels are now...

By AJMC (The American Journal of Managed Care)
FDA Signals Potential Expansion of Testosterone Therapy to Treat Low Libido in Idiopathic Hypogonadism
NewsApr 16, 2026

FDA Signals Potential Expansion of Testosterone Therapy to Treat Low Libido in Idiopathic Hypogonadism

The FDA announced it will entertain supplemental new drug applications to add low libido in men with idiopathic hypogonadism as an approved indication for existing testosterone replacement therapy (TRT) products. The move follows a December 2025 expert panel review of...

By AJMC (The American Journal of Managed Care)
Toward Equitable Access to Cell and Gene Therapies: Rethinking Co-Payments
NewsApr 16, 2026

Toward Equitable Access to Cell and Gene Therapies: Rethinking Co-Payments

Cell and gene therapies now command one‑time price tags exceeding $3 million, creating affordability challenges for the U.S. health‑care system. While patient cost sharing represents a tiny slice of total spending, deductibles and coinsurance can still impose thousands of dollars in...

By AJMC (The American Journal of Managed Care)
Integrated Care Needed as Metabolic Disease Prevalence, Costs Climb, Experts Say
NewsApr 16, 2026

Integrated Care Needed as Metabolic Disease Prevalence, Costs Climb, Experts Say

At the AMCP 2026 meeting, experts warned that metabolic disease now affects over 40% of U.S. adults and is driving rising health‑care costs. Claims data from a 22‑million‑member commercial population show metabolic conditions accounted for 13% of total spending in 2024,...

By AJMC (The American Journal of Managed Care)
Precision Medicine Gaps Persist Amid Evidence and Access Challenges: Daryl Pritchard, PhD
NewsApr 16, 2026

Precision Medicine Gaps Persist Amid Evidence and Access Challenges: Daryl Pritchard, PhD

At the AMCP 2026 meeting, senior vice‑president Daryl Pritchard highlighted persistent fragmentation, evidence gaps, and decision‑support shortfalls that curb precision‑medicine adoption. He stressed the need for robust clinical outcomes and cost‑effectiveness data to win payer and provider buy‑in. The panel...

By AJMC (The American Journal of Managed Care)
Long-Acting HIV Therapies Improve Adherence and Access Options: Kelsea Aragon, PharmD
NewsApr 16, 2026

Long-Acting HIV Therapies Improve Adherence and Access Options: Kelsea Aragon, PharmD

At the Academy of Managed Care Pharmacy meeting, Dr. Kelsea Aragon highlighted long‑acting HIV injectables as a solution to adherence gaps that plague daily oral regimens. She cited lenacapavir, dosed every six months, and cabotegravir, administered every two months, as...

By AJMC (The American Journal of Managed Care)
Community Response Teams: Extending the Rapid Response Model to Outpatient Care
NewsApr 15, 2026

Community Response Teams: Extending the Rapid Response Model to Outpatient Care

Community response teams (CRTs) adapt hospital rapid‑response principles for managed‑care settings, using predictive analytics to identify members whose health is deteriorating before they become high‑cost patients. By integrating with existing care‑management infrastructure, CRTs deliver early, targeted interventions that reduce emergency...

By AJMC (The American Journal of Managed Care)
Oncology Innovation Outpaces Managed Care’s Ability to Keep Up
NewsApr 15, 2026

Oncology Innovation Outpaces Managed Care’s Ability to Keep Up

Rapid advances in precision oncology are outpacing managed‑care systems, leaving gaps in biomarker testing, pharmacogenomics, CAR‑T access, and clinical pathway adherence. A study showed only 35.6% of eligible NSCLC patients receive targeted therapy, while DPYD testing—costing $175—could prevent $180,000‑plus in...

By AJMC (The American Journal of Managed Care)
Dry Eye Treatment Gaps Persist, Whereas Comorbid DED Does Not Affect Glaucoma Adherence
NewsApr 14, 2026

Dry Eye Treatment Gaps Persist, Whereas Comorbid DED Does Not Affect Glaucoma Adherence

Two AMCP 2026 posters revealed that only 12.4% of Medicare Advantage members newly diagnosed with dry eye disease (DED) received a prescription, with first‑line therapy delayed an average of 285 days and nearly half discontinuing without a second line. In...

By AJMC (The American Journal of Managed Care)
Breaking Down Trump's Renewed Push on Price Transparency: John Barkett, MBA
NewsApr 14, 2026

Breaking Down Trump's Renewed Push on Price Transparency: John Barkett, MBA

John Barkett, managing director at BRG, outlines the Trump administration’s renewed push for health‑care price transparency. The latest proposals would tighten disclosure rules, limiting required price files to services relevant to each specialty and making data more consumer‑friendly. The rule...

By AJMC (The American Journal of Managed Care)
Pharmacy's Rising Role in Cell and Gene Therapy: Zahra Mamoudjafari, PharmD, MBA
NewsApr 14, 2026

Pharmacy's Rising Role in Cell and Gene Therapy: Zahra Mamoudjafari, PharmD, MBA

Cell and gene therapies (CGTs) are receiving approvals faster than health‑care institutions can operationalize them. Zahra Mahmoudjafari, a clinical pharmacy leader at the University of Kansas Health System, published a framework outlining eight interdependent domains needed for financially sustainable, patient‑accessible...

By AJMC (The American Journal of Managed Care)
Reproxalap Safe for Use in Patients With Dry Eye Disease
NewsApr 14, 2026

Reproxalap Safe for Use in Patients With Dry Eye Disease

A Phase 3 trial of 0.25 % reproxalap eye drops in 757 dry‑eye disease patients found no serious treatment‑related adverse events. Mild ocular irritation was the most common side effect, occurring more often in older women. Visual acuity showed modest improvement, especially...

By AJMC (The American Journal of Managed Care)
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