While discussing the factors that managed care professionals review when assessing a pharmaceutical product’s cost versus its overall benefit, the panelists explain that the process is often challenging.
Oncologists and other health care providers, along with the FDA, must assess several factors, most importantly a drug’s risk-benefit ratio, before deciding how to approve it. And in the United States, there is no current threshold for what constitutes a reasonable price on drug therapy or helps determine what necessary approaches can help pay for expensive therapy, clarifies Michael Kolodziej, MD.
Because the money that is being spent to help pay for expensive therapy comes through insurance agencies, from taxpayers’ dollars, reminds Dr Kolodziej, the decision about how to pay for expensive treatments such as immunotherapy should be a societal decision.
The panelists agree that as our country shifts toward a value-based insurance design, the consumer will have to become more active in the economic decision-making process.
Daniel J. George, MD, explains that the decision-making process will rely heavily on providers, as they will need to supply the information important to patients so that they can make valued decisions.
Health Equity and Access Weekly Roundup: May 4, 2024
May 4th 2024This week, the Center on Health Equity and Access highlights a variety of gaps that exist in health care, spanning women's health, the rising rate of metabolic disease, and policy for LGBTQ+ and immigrant populations. The consensus among featured experts points to comprehensive care models.
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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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A new federal rule will enable thousands of immigrants in the Deferred Action for Childhood Arrivals (DACA) program to obtain health care through the Affordable Care Act; a forthcoming CMS rule is expected to lower home-based care wait times and raise caregiver wages; the HHS Office for Civil Rights has finalized 2 rules that strengthen the ACA’s health care discrimination ban.
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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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Shelly Lanning on How Employers Can Reduce Costs by Bridging Gaps in Women's Health Care
May 3rd 2024In a presentation at the Greater Philadelphia Business Coalition on Health Women’s Health Summit, Shelly Lanning, cofounder and president of Visana Health, addressed the need for comprehensive approaches in women’s health care and their coverage options.
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