Plan sponsors are able to dispute a PBM’s plan if it’s not reasonable or relevant, directly through CMS. Should PBMs refuse to provide 100% pass-through, the contract will no longer be reasonable.

In an interview with the American Journal of Managed Care®, Greenspan explained why oxygen therapy is beneficial for patients ...

A BTK inhibitor combined with standard R-CHOP produced rapid, PET-defined complete remission in high-risk DLBCL-type Richter syndrome with TP53 deletion. Delaying ibrutinib until cycle 2 was used as a ...

CMMI’s agenda centers on productivity and value-based payment expansion, including outcomes-based reimbursement, Most-Favored ...

GPT-4o achieved ICC/CCC of 0.815/0.866 versus in-person SALT scoring and 0.833/0.817 versus image-based scoring, while expert ...

Persistent underperformance of prior oncology VBC models reflects failure to measurably improve outcomes while lowering total ...

Rebecca L. Siegel, MPH, lead author of the “Colorectal Cancer Statistics, 2026” report recently published in CA: A Cancer ...

Peter Staley at CROI 2026 on defending 45 years of HIV progress: how clinicians, payers, and advocates can resist—quietly or publicly—and why it matters.

With the launch of such a service, questions surrounding what it is exactly and its efficacy in reducing drug prices have been a prominent discussion. Below, we answer some frequently asked questions ...

Orphan status in the U.S. can confer clinical-trial tax credits, user-fee exemptions, and up to seven years of post-approval market exclusivity for rare-disease programs. As a deuterated form of ...

Objective: To conduct a cost-effectiveness analysis comparing behavioral health integration (BHI) in primary care vs clinical decision support (usual care) for adult pat ...

Experts examine MFN pricing, the Great Healthcare Plan, ACA subsidies, PBM reform, and CMS talks in 2026. Lindsay Bealor ...