May 9th 2024
Some experts believe offering a subcutaneous version of nivolumab could make PD-1 inhibitors available to new groups of patients who currently lack access, such as those in rural areas.
Lowering Cardiometabolic Drug Costs May Improve Diabetes Health Outcomes
February 9th 2024Patients enrolled in a preventive drug list (PDL) benefit saw an 8.4% reduction in acute, preventable diabetes complication days, and PDL members residing in lower-income areas saw a 10.2% decrease compared with control members.
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Drug Prices and OOP Costs Increased Beyond Inflation Rates 2009-2018, But Were Not Related
January 31st 2024Drug prices in the US increased 4.4% annually and median out-of-pocket (OOP) costs increased 9.6% annually from 2009 to 2018, but there was no direct link between these amounts for individual drugs.
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Real-Time CGM Shows Benefits Over Intermittently Scanned CGM in T1D
January 16th 2024In a systematic review and meta-analysis, real-time continuous glucose monitoring (CGM) demonstrated benefits in terms of time in range, hypoglycemia, and hyperglycemia among patients with type 1 diabetes (T1D).
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Updated Guidelines Expand Lung Cancer Screening Eligibility for At-Risk Patients: Dr Melinda Aldrich
January 5th 2024Melinda C. Aldrich, PhD, MPH, associate professor in the departments of medicine, thoracic surgery, and biomedical informatics at Vanderbilt University, discussed recently updated lung screening guidelines from the American Cancer Society and the importance of equity across populations as new guidelines are developed.
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CareFirst Files Lawsuit Against J&J Over Delay Tactics for Stelara Biosimilars
January 1st 2024While the first ustekinumab biosimilar, Wezlana, was approved in October 2023, a settlement with Johnson & Johnson (J&J) will keep it off the market until 2025, preventing competition, and causing purchasers to pay substantially more for the agent.
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Top 5 Most Popular Reimbursement Content of 2023
December 31st 2023The most popular reimbursement content of 2023 included coverage of the shift from the Oncology Care Model to the Enhancing Oncology Model, reactions to the 2024 Medicare Physician Fee Schedule, and concerns around denial of services in Medicare Advantage plans.
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Understanding the Social Risk Factor Adjustment’s Effect on Star Ratings
This article examines how CMS’ adjustment for social risk factors affects the Medicare Advantage Star Ratings and the type of contracts affected by the adjustment.
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FDA Approves Enfortumab Vedotin Plus Pembrolizumab for Locally Advanced or Metastatic Bladder Cancer
December 18th 2023In the phase 3 EV-302/KEYNOTE-A39 clinical trial, the antibody-drug conjugate enfortumab vedotin plus PD-1 inhibitor pembrolizumab nearly doubled both median overall survival and progression-free survival compared with chemotherapy.
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AHIP Report Touts Medicare Advantage’s Quality Edge, but Hospital Concerns Persist
December 14th 2023A new report from AHIP shows that Medicare Advantage outperformed traditional Medicare on several clinical quality measures, including preventive screenings. However, debate continues over these plans’ cost efficiency and impact on the financial sustainability of rural hospitals.
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Stakeholder Insights on rtCGM in T2D Population Health Management
Leading payer and health system stakeholders reviewed literature and shared insights on the value of real-time continuous glucose monitoring (rtCGM) in type 2 diabetes (T2D) population health.
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Imetelstat Offers Benefits for Patients With MDS Who Are Red Blood Cell–Transfusion Dependent
December 5th 2023The past year has offered new hope for patients with lower-risk myelodysplastic syndromes. Besides imetelstat, which has an FDA deadline for action of June 2024, the agency approved luspatercept, which has a different mechanism of action.
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Hospitals Report Declining Cash Reserves, Increasing Reimbursement Delays and Denials
December 1st 2023A new report highlighting the twin pressures hospitals have faced over the last 18 months shows that as reimbursement delays and denials increased and cash and investments decreased, operating expenses have risen sharply.
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HMO and EPO Insurance Plans More Likely to Promote Use of Biosimilars
November 21st 2023Health plan type highly influences the likelihood of biosimilar uptake, with low-flexibility insurance plans more likely to have patients who either switched to a biosimilar or were initiated on a biosimilar.
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Biosimilar Substitution Can Reduce TCOC, Improve Provider Performance in Value-Based Payment Models
November 20th 2023A simulation study estimated the impact of biosimilar substitution on total cost of care (TCOC) and provider financial performance in the final performance period of the Oncology Care Model.
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AMA Continues Call for Medicare Payment System Fix During Interim Meeting
November 20th 2023The American Medical Association (AMA) is continuing to urge Congress to stop the impending 3.4% cut to physicians, and other organizations also weigh in on the pros and cons of the 2024 Medicare Physician Fee Schedule.
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Journey to Anticoagulant Access Following Payer Rejection of Apixaban
Formulary restrictions can create treatment barriers for patients with atrial fibrillation, including unnecessary delays in treatment and prescription abandonment, with vulnerable populations at greater risk.
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EOM Shows Awareness of Issues, but Provides No Resources, Says COA’s Nicolas Ferreyros
November 4th 2023The Enhancing Oncology Model is trying to address a number of the systemic challenges oncology faces without giving practices the tools and resources they need, said Nicolas Ferreyros, managing director of policy, advocacy, and communications, Community Oncology Alliance.
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Impact of Including Drug Spending in Oncology Alternative Payment Models
This study demonstrates a method for understanding the effects of drug spending in the design of alternative payment models.
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