Payers

The concluding keynote address at the Academy of Managed Care Pharmacy Nexus 2022 meeting discussed new and emerging oncology drugs in the pipeline and their potential impact on the treatment landscape as it pertains to managed care providers.

Mike Koroscik, vice president, Oncology, Allina Health Cancer Institute, presented “Preparing for Population Health in Oncology,” during the Association of Community Cancer Centers 39th National Oncology Conference, which concluded Friday.

While a majority of national lives are covered by vertically integrated insurers, the proportion varies widely at the state level from as low as 6% to as high as 97% of covered lives, according to a new American Medical Association (AMA) report about competition in the pharmacy benefit manager (PBM) sector and insurance.

New and emerging medications in the specialty drug pipeline were discussed during a keynote address at AMCP Nexus 2022 by Aimee Tharaldson, PhD, senior clinical pharmacist of emerging therapeutics at Express Scripts, with biosimilars, orphan drugs, and cell and gene therapies emerging as key trends to watch.

Two stakeholders from Avalere Health discuss the utility of patient-centric value frameworks for equitable health care delivery, as well as challenges and strategies regarding its implementation at Academy of Managed Care Pharmacy Nexus 2022.

Even though there is a 1-year gap between the Oncology Care Model and the Enhancing Oncology Model, there remain value-based oncology payment programs with private payers, said Glenn Balasky, executive director of Rocky Mountain Cancer Centers.

With more and more biosimilars reaching market, there are considerations around whether to keep patients on their current biosimilar or switch them to another biosimilar as the market dictates, said Paul Forsberg, PharmD, director of pharmacy, Minnesota Oncology.

A new review article explores how precision monitoring of blood glucose can be informed by the connections among self-care behaviors, mental health, and glucose level maintenance.

Offering a high-deductible health plan (HDHP) led to a 6.6% reduction in the probability of using substance use disorder services and a shift in spending from the plan to the enrollee.

A panel discussion at the 70th Annual Roy A. Bowers Pharmaceutical Conference addressed recent care delivery initiatives in New Jersey that aim to address health inequities and other population health concerns.

There is wide variation in the governance over research participant pay, and with rapid advances in technology enabling trial access, industry should step up and pay patients what they are worth, says Gunnar Esiason, a patient advocate living with cystic fibrosis.

The topline results showed the phase 3 trial met both the primary endpoint and all secondary endpoints.

When converting a patient to a biosimilar, having clear and consistent messaging will reduce confusion and prevent patients from having a lack of trust in the process, said Paul Forsberg, PharmD, director of pharmacy, Minnesota Oncology.

Tobacco smoking, depression, and increasing number of comorbidities were associated with reduced treatment satisfaction among patients with hidradenitis suppurativa.

Addressing the mental health crisis in the United States warrants innovation in treatment and recovery, and the development of mechanisms to provide and pay for them accordingly.

Danielle Carnival, PhD, addressed the National Comprehensive Cancer Network Policy Summit on Friday.

Consumers want telehealth and telehealth can help achieve organizational goals of avoiding unplanned care, closing care gaps, and achieving care targets.

Key stakeholders involved in the delivery of cancer care in New Jersey discuss strategies driving innovation in oncology and remaining challenges impeding their integration at the 70th Annual Roy A. Bowers Pharmaceutical Conference.

Streamlining the prior authorization process can improve care accuracy and patient access to care, writes Siva Namasivayam, CEO of Cohere Health.

Hospital price transparency data suggest that health insurance exchange (HIX) plans get lower negotiated rates than commercial group plans and higher negotiated rates than Medicare Advantage plans.

The National Comprehensive Cancer Network recommendations come as the FDA weighs an indication in chronic lymphocytic leukemia/small lymphocytic leukemia (CLL/SLL) for zanubrutinib.

While commercial payers have been engaged with the shift to biosimilars, they all have their own preferred biosimilar, which makes it challenging for practices, explained Lalan Wilfong, MD, vice president of payer relations & practice transformation at The US Oncology Network.

In 2021, the specialty drug trend rebounded from the pandemic, and it is expected to stay strong with more specialty drugs coming. Increased availability of biosimilars could shift this trend.

Effective messaging about the value of accountable care organizations (ACOs) is a key strategy if both CMS and the National Association of ACOs are to hit lofty goals, the leaders of both organizations said Thursday.

Neil Goldfarb, president and CEO of the Greater Philadelphia Business Coalition on Health (GPBCH), reviews the key topics to be addressed at the 2022 GPBCH Wellness Summit.

The 1-year gap after the end of the Oncology Care Model (OCM) means some practices have to make hard decisions regarding cost of care or the financial health of the practice, explained Lalan Wilfong, MD, vice president of Payer Relations & Practice Transformation at The US Oncology Network.

Having a biosimilar on formulary makes it more likely the biosimilar will be adopted. Length of time a biosimilar is on market can impact how likely it is to be added to formulary.

The FDA approved the first high-concentration adalimumab biosimilar. A low-concentration version of the biosimilar, Hadlima, was already approved. Both versions will launch in July 2023.

Insurance reimbursement for teleophthalmology services is not consistent among populations and only recently received a boost due to flexibilities allowed during the pandemic, said Parisa Emami-Naeini, MD, MPH, assistant professor of ophthalmology at University of California, Davis, and vitreoretinal surgeon and uveitis specialist at UC Davis Eye Center.

The Institute for Value-Based Medicine series visits Texas Oncology in Austin.