JAMA (Journal of the American Medical Association)

Insulin Costs and Use After the Inflation Reduction Act Out-of-Pocket Cap https://jamanetwork.com/journals/jama/fullarticle/2850128 This interrupted time series analysis uses Medicare Part D data from January 2021 through December 2023 to measure changes in insulin cost and use after the Inflation Reduction Act $35 cap on out-of-pocket insulin costs, overall and for insulin users with previously high out-of-pocket cost.

Insulin Cost Caps and Pharmacoequity https://jamanetwork.com/journals/jama/fullarticle/2850129 Diabetes incidence is rising in the US, with more than 40 million US residents living with this condition. Diabetes morbidity and mortality are unequally distributed, and new diagnoses are higher among American Indian/Alaska Native, Black, and Hispanic adults, compared with White adults. Managing prescription medications is critical to reducing diabetes morbidity, as is controlling risk factors and associated comorbid conditions. However, the cost of pharmacologic therapy has increased substantially, driven in part by the growing use of newer glucose-lowering agents. The high cost of these medications comprises a substantial portion of diabetes-related health care expenditure for individuals with diabetes and may result in restrictive coverage by health plans insuring enrollees with diabetes, further limiting access to care. The out-of-pocket costs faced by patients are particularly burdensome, because patients also face the consequences of adverse downstream outcomes that result from reduced medication adherence due to costs.

Finerenone in Patients With Chronic Kidney Disease Due to Glomerular Diseases Research Summary https://jamanetwork.com/journals/jama/fullarticle/2850123 This study evaluated whether finerenone, a nonsteroidal mineralocorticoid receptor antagonist, can slow loss of kidney function in patients with glomerular diseases.

Finerenone for CKD Due to Glomerular Diseases https://jamanetwork.com/journals/jama/fullarticle/2850124 This exploratory analysis of a randomized clinical trial evaluates the efficacy and safety of finerenone in reducing chronic kidney disease of participants with glomerular diseases, including disease subtype.

Low-Dose Rivaroxaban and Cardiovascular Events in Advanced Kidney Disease Research Summary https://jamanetwork.com/journals/jama/fullarticle/2850098 This study investigated whether low-dose rivaroxaban reduces major adverse cardiovascular events compared with placebo in adults with advanced chronic kidney disease (CKD) stage 4 or 5, including those receiving dialysis.

Measured and Estimated Glomerular Filtration Rates and Risk of Adverse Health Outcomes https://jamanetwork.com/journals/jama/fullarticle/2850099 This study evaluates associations between major clinical outcomes and measured glomerular filtration rate (GFR), estimated GFR (eGFR) for plasma creatinine, eGFR for cystatin C, and eGFR for a combination of plasma creatinine and cystatin C in a large cohort of patients in Sweden.

Low-Dose Rivaroxaban and Cardiovascular Events in Advanced Kidney Disease https://jamanetwork.com/journals/jama/fullarticle/2850100 This randomized clinical trial examines the safety and efficacy of low-dose rivaroxaban in the treatment of patients with advanced chronic kidney disease at high risk for cardiovascular events.

Precision, Pragmatism, and Emerging Paradigms in Determining Kidney Filtration Function https://jamanetwork.com/journals/jama/fullarticle/2850101 Chronic kidney disease (CKD) is defined largely by glomerular filtration rate (GFR), a construct with broad clinical implications. Guidelines from Kidney Disease: Improving Global Outcomes categorize CKD stages in adults according to GFR thresholds and albuminuria to assess risk of kidney failure. These CKD categories help clinicians dose medications with a narrow therapeutic window (eg, chemotherapy, antimicrobials), screen for metabolic complications of kidney dysfunction, determine eligibility for kidney transplant, and evaluate risks of death and cardiovascular disease events. Yet a patient’s GFR assessment depends on which test is ordered. In routine clinical practice, GFR is estimated (eGFR) rather than measured (mGFR). Small differences between estimates for GFR that fall close to the thresholds for CKD categorization can reclassify a patient’s disease status, thereby influencing diagnostic testing and treatment decisions. Measured GFR is the reference standard, but it is burdensome, time consuming, and not widely available. Thus, most clinical studies rely on eGFR to determine the associations of CKD with kidney failure, cardiovascular disease, and death.

Rivaroxaban for Cardiovascular Disease Prevention in Chronic Kidney Disease https://jamanetwork.com/journals/jama/fullarticle/2850102 Cardiovascular disease accounts for approximately half of all deaths among patients with advanced chronic kidney disease (CKD), including those with kidney failure requiring dialysis. Despite this disproportionate burden, effective strategies to prevent and treat cardiovascular disease in this population remain limited. Trials conducted in broader populations, including patients with mild to moderate CKD, have suggested that low-dose rivaroxaban may confer cardiovascular protection. However, extrapolating these findings to advanced CKD is problematic given the distinct biology of uremia and other CKD-specific mechanisms in advanced CKD that heighten cardiovascular risk and increase susceptibility to bleeding. Few large-scale trials have studied interventions to reduce the high incidence of cardiovascular events in patients with advanced CKD or kidney failure requiring dialysis.

Coffee, Tea, and Cognitive Function https://jamanetwork.com/journals/jama/fullarticle/2849857 To the Editor A recent study reported higher caffeinated coffee and tea intake was associated with lower dementia risk and modestly better cognitive performance in participants from the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). In adjusted models, participants in the highest vs lowest quartile of caffeinated coffee consumption had a hazard ratio (HR) of 0.82 (95% CI, 0.76-0.89) for dementia, with the most pronounced difference at a moderate intake of approximately 2 to 3 cups per day. We propose that, in addition to neurobiological effects of caffeine, part of this association may reflect more socially active lifestyles among regular coffee drinkers, which themselves protect against dementia.

Point-of-Care Ultrasound for the Diagnosis of Pneumonia https://jamanetwork.com/journals/jama/fullarticle/2849858 This JAMA Insights explores the use of point-of-care ultrasound as a less expensive, more accessible alternative to chest radiography and computed tomography for diagnosing community-acquired pneumonia.

Trials and Health Policy https://jamanetwork.com/journals/jama/fullarticle/2849859 Seldom are health policy decisions guided solely—or even primarily—by evidence from clinical trials. Indeed, there may be an inherent mismatch between the broad scope and rapid speed of most policy decisions and the deliberate specificity and methodical pace of traditional trial research. Policymakers often adopt or fund interventions for broad populations based on incomplete information, and under time pressure, budgetary constraints, and competing political demands. Clinical trialists, in contrast, may focus on generating internally valid answers to highly specific questions under carefully controlled conditions, a process that can take years of planning, data collection, and analysis. Not surprisingly, policymakers may perceive that the evidence generated by trials is too limited and arrives too late to guide many of the real-world decisions they make, while trialists may lament that sweeping policy actions are taken without robust experimental evidence demonstrating their effects.

Incentivizing Kidney Transplants While Safeguarding Equity https://jamanetwork.com/journals/jama/fullarticle/2849850 This Viewpoint discusses the US Centers for Medicare & Medicaid Services’ Increasing Organ Transplant Access Model and outlines pathways to monitor the implementation of the model to ensure equitable access for all patients.

Controversies About Osteoporotic Fracture Prevention Strategies https://jamanetwork.com/journals/jama/fullarticle/2849851 This Viewpoint considers controversies regarding osteoporotic fracture prevention strategies, noting that some currently available medications, including estrogen, are underused and poorly understood.

Patient Information: Ebola https://jamanetwork.com/journals/jama/fullarticle/2849890 This JAMA Patient Page describes how Ebola is transmitted, how common the infection is and where outbreaks have occurred, risk factors and symptoms, and how it is diagnosed and treated.

Notes From the Far End of the Stethoscope https://jamanetwork.com/journals/jamacardiology/fullarticle/2849967 This essay describes the author’s experience going from clinician to patient and back again.

Error in Results https://jamanetwork.com/journals/jamacardiology/fullarticle/2849968 The Original Investigation titled “Chronic Kidney Disease Prevalence and Awareness Among US Adults,” published on November 8, 2025, was corrected to fix an error in the awareness of chronic kidney disease diagnosis among Hispanic adults reported in the Results; the correct values are 12.5% (95% CI, 10.5%-14.4%). This article was corrected online.

Finerenone Across Cardiovascular-Kidney-Metabolic Syndrome Stages https://jamanetwork.com/journals/jamacardiology/fullarticle/2849969 This study evaluates the efficacy and safety of finerenone across cardiovascular-kidney-metabolic stages, and examines the effects of finerenone on cardiovascular-kidney-metabolic syndrome progression and regression over time.

Precardioversion Heart Rhythm Monitoring Using Smartphone PPG https://jamanetwork.com/journals/jamacardiology/fullarticle/2849970 This randomized clinical trial evaluates the efficacy and feasibility of smartphone-based precardioversion rhythm monitoring vs standard of care.

Standard-Dose Tenecteplase v Low-Dose Alteplase for Acute Ischemic Stroke From Large-Vessel Occlusion https://jamanetwork.com/journals/jamaneurology/fullarticle/2849793 This randomized clinical trial attempts to determine whether standard-dose tenecteplase at 0.25 mg/kg achieves a higher rate of recanalization on the initial angiogram than low-dose alteplase at 0.6 mg/kg in patients scheduled for mechanical thrombectomy.