The idea of cost of care should be simple, but buying healthcare is incredibly complex, states Andrew L. Pecora, MD. Most individuals do not think about the potential for developing cancer when they make healthcare-related decisions.
Payers have to consider premium costs and risk pools, and generally have to look at their actuarial budgets over 3 to 5 years. In order to make actuarially sound reimbursement decisions, it is important to look at the total cost of care. If a drug is expensive, but changes the natural course of the disease, it provides value, explains Pecora.
There are ways for oncologists to assist patients in getting appropriate coverage for their prescribed regimen. For patients with limited insurance coverage, there are patient-assistance programs. It is important for oncology practices to communicate with payers about their treatment decisions in advance and to ensure these entities that the care is appropriate.
Specialty Pharmacists at the Forefront: Elevating Care for Rare Diseases
May 1st 2024In the US, a disease is considered rare when it affects fewer than 200,000 persons, or 1 in every 1500 individuals, with an estimated total of 25 to 30 million Americans overall living with a rare disease at any given time.
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Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
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Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
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Diving Deep Into Specialty Pharmacy: Insights and Forecasts From IQVIA’s Doug Long
May 1st 2024Doug Long, MBA, vice president of industry relations at IQVIA, covered a bevy of stakeholder investment–related topics in his presentation at AXS24 on trends in specialty pharmacy, chief among them challenges facing the industry, obesity medications, generics and biosimilars, new product launches, and the outlook for the US market.
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