Building Payer-Provider Partnerships for a Stronger Health Ecosystem
At NAACOS Spring 2026, health‑system leaders argued that adversarial payer‑provider dynamics are stalling value‑based care. Panels from InnovaCare Health, Astrana Health, and Millennium Physician Group shared concrete strategies for collaborative contracts across Medicare Advantage, Medicaid, and commercial lines. Key themes included capacity‑based scheduling, a payer‑agnostic risk model, and the need for accurate member attribution. The discussion highlighted delegation, benefit‑design transparency, and treating risk as a strategic asset.
AJMC® in the Press, April 24, 2026
AJMC highlighted four peer‑reviewed studies that expose cost‑driving inefficiencies in Medicare. One shows generic dispensing rates vary widely, suggesting billions in savings if low‑cost drugs are fully utilized. Another reveals Medicare’s wage‑index formula underpays rural hospitals for device‑intensive surgeries. A...
Bispecific Antibodies Are Reshaping Multiple Myeloma Care: Prerna Mewawalla, MD
Bispecific antibodies are rapidly reshaping multiple myeloma treatment by delivering response rates up to 80% in earlier relapse settings, far surpassing the historic 30% seen with conventional therapies. These agents simultaneously bind a myeloma antigen such as BCMA, GPRC5D or...
Closing the Pediatric Care Gap Through Primary Care Reimbursement Reform: Chris Johnson, MBA
Chris Johnson, MBA, founder of Bluebird Kids Health, warns that many U.S. communities are becoming pediatric care deserts, with as few as one pediatrician for every 6,000‑7,000 children. The shortage forces families, especially those on Medicaid, to seek routine care...
Specialty Pharmacy's Critical Role as Advanced Therapies Move Into the Community: Fran Gregory, PharmD, MBA
Advanced therapies are set to expand dramatically, rising from 61 approved products today to roughly 180 by 2030. The growth includes cell and gene therapies, bispecific antibodies, and next‑generation monoclonal antibodies, many targeting high‑volume diseases such as cardiovascular and metabolic...
First Bispecific-ADC Combo Shows Strong Results in R/R Mantle Cell Lymphoma
A phase‑2 study published in Blood shows that combining the bispecific antibody mosunetuzumab with the antibody‑drug conjugate polatuzumab vedotin yields an 88.1% overall response rate in relapsed or refractory mantle‑cell lymphoma (MCL). The regimen produced a 78.6% complete response rate,...
Breast Cancer on the Rise in Women Under 50: Rani Bansal, MD
The American Cancer Society’s 2025 report shows women under 50 now face an 82% higher breast‑cancer risk than men, up from 51% in 2002. Incidence of estrogen‑receptor‑positive tumors is climbing, driven by later child‑bearing, fewer births, reduced breastfeeding, rising obesity...
Lunsotogene Parvec Becomes First FDA-Approved Gene Therapy for OTOF-Related Hearing Loss
Regeneron’s lunsotogene parvec‑cwha (Otarmeni) received accelerated FDA approval as the first gene therapy for OTOF‑related hearing loss. The single‑dose AAV vector is indicated for patients with severe‑to‑profound sensorineural loss who have confirmed biallelic OTOF variants and no prior cochlear implant....
Early ALPHA3 Data Could Signal Shift to Frontline Use of CAR T in LBCL
Allogene Therapeutics reported that its off‑the‑shelf CAR‑T product cemacabtagene ansegedleucel (cema‑cel) achieved 58.3% minimal residual disease (MRD) negativity at day 45 versus 16.7% with observation in the interim futility analysis of the phase 2 ALPHA3 trial. The study enrolled LBCL patients who...
What You Should Know About National Prescription Drug Take Back Day
The DEA’s 30th National Prescription Drug Take Back Day is set for Saturday, April 25, 2026, with roughly 4,200 drop‑off sites across the United States. The event offers a free, anonymous way for the public to discard expired or unused...
FDA Approves Dupilumab for Young Children With Uncontrolled CSU
The FDA has approved dupilumab (Dupixent) for children ages 2‑11 with uncontrolled chronic spontaneous urticaria (CSU), marking the first biologic therapy for this pediatric group. The decision is based on the LIBERTY‑CUPID phase 3 program, which demonstrated significant reductions in itch...
Cognitive Decline May Begin Up to 8 Years Before CVD Events in Older Adults
A large nested case‑control analysis of the ASPREE trial found that older adults who later suffered a cardiovascular event experienced accelerated declines in global cognition, memory, processing speed and verbal fluency. The cognitive deterioration began three to eight years before...
Cataract Surgery Success in Most Patients Defined by MIPS
A new JAMA Ophthalmology study finds that the Merit‑Based Incentive Payment System (MIPS) measure 191 labels cataract surgery as successful for most patients, but it excludes nearly half of all cases, disproportionately affecting older and Black patients. Using data from...
Oncology Leaders Address Testing, Access, Equity, and Pharmacy in Cancer Care
On March 12, 2026, the American Journal of Managed Care convened Chicago oncology leaders to discuss precision testing, equity, and pharmacy integration in cancer care. Panels emphasized universal biomarker testing for lung cancer, highlighted gaps such as low EGFR testing...
First Non-INSTI, Tenofovir-Free Regimen DOR/ISL Gains FDA Approval for HIV
The FDA has approved Merck’s Idvysno, a once‑daily, single‑tablet combination of doravirine and islatravir, marking the first non‑INSTI, tenofovir‑free two‑drug regimen for adults with virologically suppressed HIV‑1. Phase 3 trials demonstrated non‑inferior viral suppression compared with standard three‑drug regimens, with only...
FDA Expands Teplizumab-Mzwv Approval to Young Children With Stage 2 T1D
The FDA granted supplemental approval for Sanofi’s teplizumab‑mzwv (Tzield) to treat children as young as one year with stage 2 type 1 diabetes, expanding the prior 8‑year‑and‑up indication. The decision follows interim data from the PETITE‑T1D phase 4 trial, where 23 children received...
988 Lifeline Launch Linked to 11% Drop in Youth Suicide Deaths
The nationwide rollout of the 988 Suicide and Crisis Lifeline is linked to an 11% decline in suicide deaths among Americans aged 15‑34, saving an estimated 4,372 lives between July 2022 and December 2024. States with the largest increase in answered calls...
Medication Use Up for OUD as Diagnoses Decline Among Medicaid Beneficiaries
A new JAMA Network Open study finds that while opioid use disorder (OUD) diagnoses among Medicaid beneficiaries fell from 4.2% in 2019 to 3.6% in 2023, the share receiving medication for OUD (MOUD) rose from 60.0% to 69.1% over the...
PFAS Exposure Linked to Higher Nonmelanoma Skin Cancer Risk, Especially in Older Adults
A new study using eight NHANES cycles (2003‑2018) links higher serum perfluorodecanoic acid (PFDA) exposure to increased odds of non‑melanoma skin cancer (NMSC), especially in adults aged 60 and older. Participants in the middle PFDA tertile showed a 73% higher...
The Cost of Implementing and Sustaining the Massachusetts Model
A microcosting study of the Massachusetts Model (MA Model) for office‑based opioid use disorder treatment found average implementation costs of $238,888 per clinic ($3,185 per patient) and annual sustainment costs of $229,676 per clinic ($3,062 per patient). Variable costs, chiefly...
Expanding the Toolkit: Non-Statin Therapies, Broader Populations, and Closing the Treatment Gap
The 2026 ACC/AHA guideline now gives strong, Class I recommendations for non‑statin therapies—bempedoic acid, PCSK9 antibodies, ezetimibe and inclisiran—for patients who cannot tolerate statins. It endorses combination regimens, such as a moderate‑intensity statin plus ezetimibe, which the RACING trial showed matches...
NIMBLE Trial Shows Efficacy of Cemdisiran in gMG: Tuan Vu, MD
The phase 3 NIMBLE trial evaluated cemdisiran, an RNA‑interference therapy, in patients with generalized myasthenia gravis (gMG). Over 26 weeks, cemdisiran monotherapy and its combination with pozelimab both achieved statistically significant improvements on the MG‑ADL scale versus placebo, and met the key...
Insurance-Provided Grocery Assistance and Health Care Outcomes Among Patients With Diabetes
A new low‑premium health plan from Elevance Health that includes a $1,200‑$3,000 annual grocery benefit was offered to income‑eligible members with type 2 diabetes. Using a doubly robust difference‑in‑differences design, researchers compared 411 members who enrolled with 961 eligible non‑enrollees. The...
Unmet Needs and Key Takeaways for Community Oncologists
Community oncologists face unresolved questions in prostate cancer treatment, especially the optimal sequencing of chemotherapy with androgen‑receptor pathway inhibitors (ARPIs) added to ADT. Existing trials such as ARCHES and PEACE‑1 were designed around ARPI‑plus‑docetaxel, leaving uncertainty about the benefit of...
Selecting Patients for Immunotherapy in CSCC: Key Considerations
Cutaneous squamous cell carcinoma (CSCC) treatment is shifting toward earlier use of systemic immunotherapy, especially for moderate‑risk tumors that are still resectable. Dr. Vishal Patel of George Washington Cancer Center urges clinicians to evaluate checkpoint inhibitors alongside surgery, guided by...
PSMA PET and the Evolving Imaging Landscape in Prostate Cancer
In the 2026 prostate cancer guidelines, PSMA‑PET is elevated to an indispensable imaging tool, expanding beyond initial staging of unfavorable intermediate‑risk and higher‑risk disease to cover biochemical recurrence, including second recurrences. The modality now informs decisions on oligometastatic identification for...
Rethinking When to Start Long-Acting HIV Therapy
Real‑world data from the OPERA cohort of over 5,000 patients show that starting long‑acting cabotegravir plus rilpivirine (CAB+RPV LA) in individuals with detectable viral loads—about 11% above 50 copies/mL—can still achieve virologic suppression comparable to patients who begin treatment already...
The Future of Psoriasis Management: Integration, Innovation, and Holistic Care
Psoriasis management has shifted from modest skin improvement to aiming for complete clearance, driven by a growing arsenal of topicals, biologics, and emerging oral IL‑23 inhibitors. Real‑world data from the Winter Clinical Hawaii 2026 conference show higher persistence with biologics among...
Delgocitinib Maintains QOL, Productivity Improvements at 52 Weeks in Chronic Hand Eczema
The open‑label DELTA 3 extension of the phase 3 delgocitinib trials shows that patients with moderate‑to‑severe chronic hand eczema who continued with twice‑daily or as‑needed delgocitinib cream for a full year maintained significant gains in disease‑specific and generic quality‑of‑life scores. Across 472...
Population-Based Study Links Psoriasis with Sleep Disorders
A new population‑based study of 168,452 adults found that people with psoriasis face significantly higher three‑year risks of several sleep disorders, including hypersomnia (RR = 2.04), insomnia (RR = 1.49), restless‑leg syndrome (RR = 1.31) and sleep apnea (RR = 1.17). The analysis matched 84,226 psoriasis patients with...
Managing Infection Risks in BCMA Bispecific Antibody Therapy: Ajay K. Nooka, MD, MPH
The FDA granted full approval to teclistamab (Tecvayli), a BCMA bispecific antibody for relapsed/refractory multiple myeloma, despite grade 3‑4 infection rates of 50‑60 percent observed in early trials. Ajay K. Nooka, MD, MPH, explained that these infections occurred largely during the COVID‑19 pandemic...
Late Diagnosis of Hepatitis B and C Remains a Global Challenge
A systematic review of 22 studies finds that late diagnosis of chronic hepatitis B and C remains widespread, affecting 11‑70% of HCV cases and 15‑51% of HBV cases. Older age, male sex, diabetes, alcohol misuse, and limited healthcare engagement are...
Inconsistent Use of “Not Better Explained” Criterion Raises Questions in Sleep Disorder Diagnosis
A systematic review published in the Journal of Sleep Research reveals that the “Not Better Explained” (NBE) exclusion criterion is applied inconsistently across the ICSD‑3‑TR and DSM‑5‑TR sleep disorder classifications. The ICSD‑3‑TR includes NBE in nine of ten disorders, while...
Co-Pay Models and AFPs Shift Costs but Raise Access Concerns: Patty Taddei-Allen, PharmD, MBA
Co‑pay accumulators, maximizers, and alternative funding programs (AFPs) are gaining traction as insurers and PBMs attempt to curb rising drug costs. While accumulators and maximizers keep the existing benefit design, they shift more out‑of‑pocket expenses onto patients. AFPs, by contrast,...
Alternatives to PAIN Act Raises Access and Market Stability Concerns: Adam Colborn, JD
At the AMCP annual meeting, officials discussed the Alternatives to PAIN Act, a proposal that would lower cost‑sharing and eliminate utilization restrictions for certain non‑opioid pain drugs under Medicare Part D. Associate vice‑president Adam Colborn warned that such mandates could destabilize the...
AMPLIFY Redefines CLL Care: Adam Kittai, MD
The FDA has cleared acalabrutinib (Calquence) combined with venetoclax (Venclexta) as the first all‑oral, fixed‑duration regimen for chronic lymphocytic leukemia. The approval follows the phase 3 AMPLIFY trial, which demonstrated superior progression‑free and overall survival compared with traditional chemoimmunotherapy. The study...
Initiation of the Interchangeable Biosimilar Insulin Glargine-Yfgn Among Older Adults
A Pennsylvania study of adults 65 and older found that only 3.7% initiated the interchangeable biosimilar insulin glargine‑yfgn (Semglee or unbranded version) between 2022 and mid‑2023. Initiators were disproportionately rural residents, long‑term‑care (LTC) patients, and those with three or more...
Oncology Trends and Testing Gaps Shape Precision Care Delivery: Abby Kim, PharmD
At the Academy of Managed Care Pharmacy’s April meeting, experts outlined six emerging oncology trends reshaping precision care. Abby Kim, senior director at Prime Therapeutics, warned that biomarker testing gaps are delaying patients’ access to proven novel therapies. AMCP is...
Treatment Delays, Denials More Common in Prescriptions Initially Rejected
A new JAMA Health Forum study examined 205,896 brand‑name prescription fills that were initially rejected through prior authorization (PA). Only 54% of these prescriptions were eventually approved, with a mere 7% receiving same‑day approval and the majority delayed by multiple...
Patients With Scarring Alopecia Value Expertise of Specialist Dermatologists
A new CAPAIR survey of 1,047 scarring alopecia patients shows that those who see hair‑specialist dermatologists (HSDs) report higher satisfaction and receive more aggressive therapy than patients seen by general dermatologists (GDs). HSDs were rated “excellent” for disease knowledge by...
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...
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...
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...
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...
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...
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,...
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...
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...
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...
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...