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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.

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.

Research presented at AMCP Nexus this week explores barriers to prescriptions for atopic dermatitis.

Adults newly diagnosed with narcolepsy type 1 rack up healthcare costs 5.5 times higher than people without the condition, a Takeda-funded analysis finds, even with treatments available.

Federal HIV guidelines add Bixlenvo as a switch option, back statins for adults 40 to 75 and urge clinicians to challenge payer barriers to antiretroviral therapy (ART).

Sempre Health CEO Anurati Mathur says affordability dollars should reach patients on every fill, and reversed claims show plans when they don’t.

Based on her findings, Mathur shared members in a UPMC affordability program were more adherent to heart drugs, with fewer ER visits and no significant rise in total cost of care.

COPD patients who saw a care navigator had a 20% readmission rate vs. 35% for those who didn’t, in a quality improvement project at St. Joseph's Hospital in Tampa, Florida, according to research presented at CHEST 2026 meeting last week in Phoenix..

A standardized discharge checklist and care coordination cut 30-day COPD readmissions from 27.9% to 18.2%, according to research presented at CHEST 2026.

A Cencora analysis of 32 pre-approval products found more than 60% of payer engagement with PIE resources came more than 90 days after posting.

AMCP leaders say PBM reform, new drug pricing models and AI will shape this week’s Nexus meeting in San Diego.

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.

Stanford Health Care’s Janjri Desai, Pharm.D., says pharmacy should be treated as a clinical service line, not just a 340B financial workhorse.