Prior Authorization

A Bispecific Moved Earlier in Myeloma, and Brought Its Infection Risk With It

George Padron
Oncology Care, Hematologic Malignancies, Access & Affordability, Prior Authorization | Aug 2, 2026
MajesTEC-9 in NEJM found teclistamab monotherapy improved progression-free and overall survival in earlier-line myeloma, with common grade 3-4 infections.

AI for Managed Care Administration: Enhancement or Replacement? (Part 1)

George Padron
Podcasts, Healthcare Systems & Business, Digital Health & AI, Prior Authorization, Value Based Care | Jul 27, 2026
Dr. Randy Vogenberg discusses integrating AI into managed care, focusing on clinical pathways and expert guidelines.

Merck's Oral PCSK9 Inhibitor Approval Undercuts Injectables

George Padron
Specialty Medicine, Healthcare Headlines, FDA & Regulations, Cardiology, Access & Affordability, Prior Authorization, Managed Care, Formulary & Coverage, Pharmacy Benefit Trends | Jul 17, 2026
FDA has approved Lipfendra (enlicitide), the first oral PCSK9 inhibitor, priced at $315 per month. Merck has positioned it below injectable options, transitioning PCSK9 medications into retail pharmacies.

Utah Tests AI Prescription Renewals as Doctors Push Back

Sonia Reyes
Digital Health & AI, Workforce & Practice, Access & Affordability, Prior Authorization | Jul 2, 2026
Utah's regulatory sandbox lets a startup's AI renew prescriptions under physician review, drawing safety and liability objections from doctors and the AMA

Patient Selection as the Pivot: Bariatric Surgery Coverage After 65

George Padron
Specialty Medicine, Endocrinology & Metabolic, Access & Affordability, Prior Authorization, Coverage & Appeals, Managed Care | Jun 1, 2026
A Vienna cohort of 111 adults 65+ found bariatric surgery drove durable weight loss and comorbidity remission over 5 years, but with a ~9% reoperation rate.