- Center on Health Equity and Access
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Drug Costs and Benefit Design
Genevieve Kumapley, PharmD, BCOP, reflects on the significant out-of-pocket (OOP) costs associated with oral oncolytics and suggests how a change in benefit design can help patients afford the treatments they need.
“[Under the prescription benefit,] patients are required to now cover anywhere from 25% to 30% of costs, notes Dr Kumapley. “That’s significant.”
High costs burden patients and affect their adherence to treatment, remarks Dr Kumapley. For instance, patients prescribed high-cost drugs are less likely to fill their prescriptions, and although patient assistance programs are available to assist patients with the costs of treatment, drug benefit design should be reevaluated.
Dr Kumapley explains that currently, while intravenous therapies are covered under the medical benefit, oral oncolytics are covered under the prescription benefit. There is a large disparity in patient OOP cost, with the patient responsible for a higher cost under the prescription benefit. In oncology, she adds, coverage of oral oncolytics under the medical benefit may be more beneficial in terms of reduced patient OOP cost.
CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
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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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The Joint Commission is launching the Rural Health Clinic Accreditation Program to standardize staff training and patient care practices at rural health clinics nationwide; the American Cancer Society recently launched the largest-ever study of cancer risk and outcomes in Black women; the HHS COVID-19 vaccination campaign saved $732 billion by preventing illness and related costs.
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Budesonide-Based Triple Therapy Shows Best Benefit Over Dual Therapy for COPD
May 8th 2024The triple therapy of budesonide, glycopyrrolate, and formoterol fumarate showed the greatest incremental net benefit among a series of triple therapy medications that were evaluated against dual therapy for chronic obstructive pulmonary disease (COPD), according to an analysis presented at ISPOR.
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