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Hard-to-control hypertension, comprising uncontrolled and resistant hypertension, is highly prevalent, meaning many patients with hypertension remain at risk of adverse outcomes despite treatment. To discuss the role of managed care in addressing hard-to-control hypertension, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in November 2025. This article provides a qualitative summary of the panel discussion. Key insights were that despite multiple effective, low-cost pharmacotherapy options, a significant proportion of patients have blood pressure above recommended goals because of confounding factors at both the micro and macro levels; and managed care-specific challenges in hard-to-control hypertension include competing organizational priorities, data gaps, and lack of integration of existing resources. Opportunities to advance care in hard-to-control hypertension include focusing on prevention and providing additional patient and clinician support such as with education and enhancing use of digital technologies. Other insights were that top payer priorities in hypertension include reducing cardiovascular events and other complications and meeting quality goals, and that current clinical guidelines and provider input are important elements of payer decision-making. These findings can support informed clinical and coverage decisions, can offer practical actions for payers, and may inform future work.