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Understanding Insurance Coverage Policies for Incretin Mimetics for Weight Management

The high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.

Emerging Data Suggest Select Benefit for Venetoclax in MDS: Ivo Carre, PhD

Ivo Carre, PhD, shares subgroup data that points to potential benefit in younger patients with high-risk MDS.

Budget Impact Analysis of Biosimilar Natalizumab in the US

Projected savings from biosimilar natalizumab were $452,611 over 3 years, driven by decreased drug acquisition costs and a utilization shift from reference to biosimilar natalizumab.

Value-Based Care Through Postacute Home Health Under CMS PACT Regulations

Among a patient population defined by CMS postacute care transfer regulations, home health vs no postacute care was associated with reduced 30-day readmissions and costs.

Clinical Profile of COVID-19 Infection in Postvaccination Individuals

This article describes the findings of an observational study carried out in India to examine the clinical profile of individuals detected to be COVID-19 positive post vaccination.

Association Between Use of Clinician Performance Information and Patient Experience

High patient experience scores were associated with the collection and use of any clinician performance information, especially with whether the practice shared this information internally to compare.

Continuity of Opioid Prescribing Among Older Adults on Long-term Opioids

Among older adults with chronic noncancer pain on long-term opioid therapy, greater continuity of opioid prescribing was significantly associated with fewer opioid-related adverse outcomes.

Rising Use of Surveillance Colonoscopy and Potential Impacts

The proportion of colonoscopies performed for postpolypectomy surveillance has increased significantly, particularly among older patients with limited life expectancy, raising concern for possible overuse.

Industry-Informed Perspectives on the Benefits of Rideshare-Based Medical Transportation

Previous research on rideshare-based nonemergency medical transportation has limited generalizability due to the specific model studied, and the lack of trip-level data raises concerns of ecological fallacy.

Evaluating Satisfaction With Pharmacist-Provided MTM Services in a Medicaid Population

Medication therapy management (MTM) services were performed with a cohort of Medicaid patients, and their satisfaction with the program was assessed as part of a quality improvement initiative.

Factors Associated With Lung Cancer Risk Factor Documentation

This cross-sectional observational study found several factors associated with whether a patient had sufficient lung cancer risk factor documentation in the electronic health record.

Validation of the FINE-CKD Model for Future Health Technology Assessments for Finerenone in Patients With Chronic Kidney Disease And Type 2 Diabetes

Increased Payments to Medicare Advantage Plans for Dually Eligible Beneficiaries

Increasing Medicare Advantage payments for full Medicaid enrollees was not associated with meaningful changes in inpatient or nursing home use.

Hospital Participation in Medicare ACOs: No Change in Admission Practices and Spending

Hospital accountable care organization (ACO) participation did not impact emergency department admission rates, length of stay, or costs, suggesting limited effectiveness in reducing spending for unplanned admissions and challenging hospital-led ACO cost-saving strategies.

Consumer-Centric Approach to Enhance Access to Pediatric Specialty Care

The authors’ organization optimized scheduling techniques that improved patient access to pediatric specialists to within 7 calendar days for new patients.

An Assessment of Nurse Practitioner Low-Value Care Use in Primary Care

Primary care nurse practitioners were found to use low-value care at lower or relatively similar rates compared with the general clinician population.

Factors Associated With Lung Cancer Risk Factor Documentation

This cross-sectional observational study found several factors associated with whether a patient had sufficient lung cancer risk factor documentation in the electronic health record.

Primary Care Nurse Practitioner Management of Adolescent Behavioral Health

Personnel costs ($90,514) of a primary care–embedded adolescent behavioral health nurse practitioner over 2 years were 63% of the potential revenue generated ($144,449).

How Value-Based Care With Provider Enablement Improves Maternal and Infant Outcomes in Medicaid

Supported value-based care improves prenatal care while reducing neonatal intensive care unit stays, preterm birth rates, low birth weight rates, and costs for mothers and infants.

Addressing Cancer Care Barriers Through Community Outreach and Support

February 4 is World Cancer Day, and in these interviews with our Strategic Alliance Partner, NYU Langone Health, we learn about the importance of forming strong relationships with the communities you are located in and with whom you work to optimize cancer-related outcomes.

Real-World Insights on Biomarker Testing Patterns and Implications for mNSCLC Therapy Selection

FDA Approves bluebird bio's Lovo-Cel Gene Therapy for Sickle Cell Disease

The decision was supported by efficacy data from 36 patients from the ongoing phase 1/2 HGB-206 trial (NCT02140554) and 2 patients in the phase 3 HGB-210 trial (NCT04293185). It was the second approval from FDA for a gene therapy for sickle cell disease.

Estimating the Economic Burden of Migraine on US Employers

The Migraine Impact Model is an interactive calculator that estimates migraine prevalence within a workforce and the associated economic burden of migraine on the employer.

Adolescent Anterior Cruciate Ligament Reconstruction: A Decade of Rising Surgical Cost

Adolescent anterior cruciate ligament reconstruction surgery can preserve health and restore function of the knee joint, but the surgical cost has outpaced inflation.

Addressing Cost Barriers to Medication Adherence: Sam Peasah, PhD

Sam Peasah, PhD, MBA, RPh, director of High-Value Health Care Value-Based Pharmacy Initiatives at UPMC Health Plan, discusses ways that health plans can help reduce the cost burden of medications to improve adherence.

Accountable Care Organizations: Looking for Answers to an Overspending, Underachieving System

Effects of an Out-of-Pocket Maximum in Medicare Part D

This study compares the impact of the 3 different out-of-pocket maximums proposed in Congress and by the Medicare Payment Advisory Commission.

The Impact of Immune Checkpoint Inhibitors on Cost and Quality of Life in the Initial Treatment of Patients With Advanced or Metastatic NSCLC

Immune checkpoint inhibitors (ICIs) represent a significant benefit for the initial treatment of patients with advanced or metastatic non−small cell lung cancer (NSCLC). Beyond clinical benefit of increased overall survival, it represents a class of medications with a favorable adverse effect profile compared with chemotherapy. Drugs that target programmed cell death protein 1 (PD-1) receptor and its ligand PD-L1 are ICIs that work by taking the brakes off the immune system and promote T-cell−mediated cancer cell destruction. Current NCCN guidelines recommend that all patients with advanced or metastatic NSCLC have their PD-L1 status (amount of PD-L1 on cancer cells) assessed to guide treatment section. However, this recommendation is not always followed and may lead to inappropriate treatment selection and potential increased cost. Through appropriate biomarker testing, subsequent appropriate utilization of ICIs may help to drive down other costs and improve health-related quality of life. Managed care pharmacists should continue to focus on promotion of guideline concordant care that includes appropriate biomarker testing and selection of an evidence-based preferred treatment option.

Gaps in the Coordination of Care for Older Adults With or at Risk for Cardiovascular Disease

Older adults with cardiovascular disease (CVD) or CVD risk factors report that gaps in communication among their providers are common and hazardous.