Reimbursement

Latest News

July 7th 2025

How AI Can Address the Troubled Business Model in Oncology

By Mary Caffrey

July 5th 2025

At ASCO, Testing and AI Rival Drugs for Attention, but Reimbursement Remains a Barrier

By Mary Caffrey

June 30th 2025

Without IRA Fix, COA Warns Community Oncology Practices Will Shut Down

By Mary Caffrey

June 26th 2025

SCOTUS Rules Abortion Clinics Can Not Challenge South Carolina’s Medicaid Order

By Julia Bonavitacola

NCCN Summit Seeks to Build Better Connections Between Oncology and Primary Care

By Mary Caffrey

Video Interviews

July 7th 2025

Medina v Planned Parenthood Could Have Implications With Medicaid Funding: Jennifer Evans, JD

July 3rd 2025

Supreme Court Decision Marks a Failed Attempt at Attacking ACA: Jeffrey Fitzgerald, JD

July 2nd 2025

Medina v Planned Parenthood Case Reinterprets Any Willing Provider Provision: Jennifer Evans, JD

May 27th 2025

Oncology Advances Bring CAR T Local, but Community Practices Need Support: Nini Wu, MD

March 15th 2025

How Do Infusion Pharmacies Support Financial Sustainability in Oncology?

October 31st 2024

Legislation Can Help Increase Uptake of PDTs, Improve Reimbursement

October 20th 2024

EOM Improved Over OCM, but Challenges Remain for Practices

September 27th 2024

EOM Adjustments Make it Easier for Practices to Say “Yes” to Participation

September 11th 2024

The Challenge of Living in Both FFS and Value-Based Care Worlds

August 28th 2024

Dr Katherine Baker Emphasizes the Importance of Collaboration Between Physicians, Payers

Podcasts

March 26th 2024

Exploring Medicare Advantage Prior Authorization Variations

August 1st 2023

Oncology Onward: A Conversation With Dr Debra Patt of Texas Oncology

More News

Patient navigation | Image credit: AON

April 22nd 2025

With Thyme Care Partnership, AON Achieves $6M in Savings in EOM’s First Performance Period

inflation reduction act | Image credit: Vitalii Vodolazskyi -stock.adobe.com

April 2nd 2025

The IRA’s Unintended Consequences for Drug Pricing and Coverage

Skylar Jeremias

The Inflation Reduction Act (IRA) may be restricting Medicare Part D formularies, increasing patient costs, and stifling pharmaceutical innovation, experts warned at the Academy of Managed Care Pharmacy 2025 annual meeting.

March 18th 2025

Texas Oncology to Roll Out Canopy for ePROs After Head-to-Head Pilot

Mary Caffrey Rose McNulty

Debra Patt, MD, PhD, MBA, executive vice president of Public Policy and Strategy for Texas Oncology, said the practice received positive feedback from nurses and patients during a pilot that concluded in February.

Kirollos Hanna, PharmD

January 29th 2025

Embracing EOM, Enhancing Collaboration and Cost Management: Dr Kirollos Hanna

Kyle Munz Kirollos Hanna, PharmD

The design of the Enhancing Oncology Model (EOM) was a perfect fit for Minnesota Oncology.

Class action book and gavel | Image credit: Zerbor – stock.adobe.com

November 5th 2024

GoodRx, PBMs Hit by Price Fixing Lawsuits

Hayden E. Klein

Independent pharmacies have filed 3 class action lawsuits against GoodRx Holdings and major pharmacy benefit managers (PBMs).

Screenshot of an interview with Stuart Staggs

October 27th 2024

The Challenge of Addressing Drug Spend to Drive Down Total Cost of Care in EOM

Laura Joszt, MA

Stuart Staggs, vice president of transformation and shared services at McKesson, explained that oncology practices in the Enhancing Oncology Model (EOM) have a tough job driving down costs when drug costs make up a larger portion of the total cost of care.

Stethoscope on money | Image credit: utah51 - adobe.stock.com

October 17th 2024

Pressure on Congress to Reform Medicare Physician Fee Schedule, Prevent Reimbursement Cuts

Laura Joszt, MA

A new letter signed by more than 230 members of the House urges Congress to not only block the scheduled 2.8% reimbursement cut, but also reform the Medicare Physician Fee Schedule.

October 14th 2024

The Daily Balancing Act of Value-Based Cancer Care

Laura Joszt, MA

Doing Things Differently: Wilfong Moves to Thyme Care

October 12th 2024

Doing Things Differently: Wilfong Moves to Thyme Care

Lalan Wilfong, MD, a 20-year medical oncologist with Texas Oncology, is senior vice president, value-based care, Thyme Care.

October 12th 2024

Beyond Navigation: Thyme Care Ready for Heavy Lifts to Make Value-Based Care Work

AJMC

September 19th 2024

Care Transition Management and Patient Outcomes in Hospitalized Medicare Beneficiaries

Mariétou H. Ouayogodé, PhD Brianna Hardy, BS John Mullahy, PhD Maureen A. Smith, MD, PhD, MPH Ellen Meara, PhD

Hospital care transition activity facilitates uptake of Medicare-reimbursed transitional care management, which is associated with lower spending and better patient outcomes.

September 17th 2024

Part B Losses to Oncologists Due to IRA Could Total $12B Through 2032 Across Medicare, Commercial Plans

Based on an Avalere Health report, Community Oncology Alliance warns that IRA negotiations could slice down payments needed to administer cancer drugs.

While shares varied by payer market, 73.6% of retail prescriptions overall were attributed to CVS Caremark, Optum Rx, and Express Scripts in the study. | Image credit: DedMityay - stock.adobe.c

September 10th 2024

A Highly Concentrated PBM Market Highlights Need for Policy Changes

The findings may help inform policy changes at the federal level aiming to address unfair and deceptive pharmacy benefit manager (PBM) practices.

Nick Ferreyros of Community Oncology Alliance during a video interview

September 10th 2024

IRA Negotiated Drug Prices Can’t Come “On the Backs of Providers”

Alexandra Gerlach Laura Joszt, MA

There are concerns that the negotiated drug prices under the Inflation Reduction Act (IRA) are leading to large provider reimbursement cuts, explained Nick Ferreyros, managing director, Community Oncology Alliance.

The process for regulatory approvals varies by country and may impact patient access to medication | image credit: thanksforbuying - stock.adobe.com

September 3rd 2024

Timeframe of Drug Approval to Reimbursement Lags in US Compared With Europe

A comparative analysis investigating time from a drug's approval to insurance reimbursement found that the speed of this process in the US falls behind some European countries.

AJMC

September 3rd 2024

Beyond Average Spending: Distributional and Seasonal Commercial Insurance Trends, 2012-2021

Erin L. Duffy, PhD, MPH Sarah Green, BA Samantha Randall, BA Erin Trish, PhD

Analysis of 2012-2021 commercial claims demonstrates that spending growth was concentrated among the highest spenders and there was increasing subsidy across enrollees through cost-sharing design.

AQUA Registry Data Support Move to Value-Based Care in Urology

August 27th 2024

AQUA Registry Data Support Move to Value-Based Care in Urology

Laura Joszt, MA

National data sets and registries are able to provide outcomes data and process measures that testify to quality of care being delivered, said Matthew Nielsen, MD, FACS, chair, Department of Urology, University of North Carolina School of Medicine.

Kempton Presley, MPH, MS

August 26th 2024

Contributor: A Behavioral Science–Based Approach to Engaging the Highest-Risk, Hardest-to-Reach Patients

Kempton Presley, MPH, MS

Strategies to help Medicare Advantage plans boost Star Ratings by improving medication adherence among seemingly “unengageable” members

Pile of US dollars | Image Credit: Stillfx - stock.adobe.com

August 19th 2024

Reaction Mixed After CMS Unveils Negotiated Medicare Drug Prices

Brooke McCormick

Some groups praised CMS after it announced the 10 negotiated Medicare drug prices while others criticized its potential impacts on drug competition and development.

COA seal | Image : COA

August 16th 2024

Revised EOM Offers More Favorable Opportunities for Community Practices, Experts Say

August 16th 2024

Payment Cuts for Independent Oncologists Would Continue Under CMS’ Proposed 2025 Physician Fee Schedule

Mary Caffrey Giuliana Grossi

Federal Trade Commission | Image: Investopedia

August 15th 2024

In July, PBMs Find Themselves in the Federal Government Hot Seat

"Medicare Advantage" written in an open notebook | Image Credit: dizain - stock.adobe.com

August 12th 2024

Medicare Advantage Hits 32.8M Enrollees, 54% of Spending

Brooke McCormick

Medicare Advantage (MA) enrollment has grown to 32.8 million in 2024, representing 54% of total Medicare spending, with significant variation in enrollment across states and counties.

Prescription for medication | Image credit: goodmanphoto - stock.adobe.com

August 2nd 2024

5 Things to Know About PBMs’ Influence on Drug Costs and Access

As pharmacy benefit managers (PBMs) come under increased scrutiny from regulatory agencies, here are 5 things to know about their role in the health care system.

AJMC

June 12th 2024

Hospital Strategies in Commercial Episode-Based Reimbursement

Scott E. Regenbogen, MD, MPH Shelytia Cocroft, PhD Sarah L. Krein, PhD, RN Michael P. Thompson, PhD

This study reports qualitative findings from an explanatory sequential mixed-methods investigation to understand hospitals’ approaches to a novel commercial episode-based reimbursement incentive program.

Bundled Payments Lead to Quality Improvements in Hospitals’ Skilled Nursing Facility Referral Networks

June 7th 2024

Bundled Payments Lead to Quality Improvements in Hospitals’ Skilled Nursing Facility Referral Networks

Sunny C. Lin, PhD, MS Russell J. Funk, PhD Andrew M. Ryan, PhD Karen E. Joynt Maddox, MD, MPH John M. Hollingsworth, MD, MS

The Bundled Payments for Care Improvement program was associated with improved quality of skilled nursing facilities in hospital referral networks for patients undergoing surgery for joint replacement.

What We’re Reading: Hospitals Charge Insurers More Than Medicare Rates; Recipient of Pig Kidney Transplant Dies; Mail-Ordered Abortion Pills Deemed Safe, Effective

May 14th 2024

What We’re Reading: Reimbursement Rate Disparities; Recipient of Pig Kidney Dies; Mail Order Abortion Pills Safe, Effective

A new study highlights significant disparity in reimbursement rates across states between hospitals and Medicare; the first patient to receive a genetically modified pig kidney has died; research examines outcomes of over 500 patients receiving medication abortion pills by mail.

Pills, thermometer, inhaler and money | Image credit: Sebastian - stock.adobe.com

May 10th 2024

Public Hospitals More Likely to Extend Unprofitable Services After 340B Participation, Study Finds

Public hospitals were significantly more likely to sustain access to unprofitable services following 340B Drug Pricing Program participation, while nonprofit hospitals were mostly unaffected, according to a recent study.

Stethoscope on money | Image credit: utah51 - stock.adobe.com

May 6th 2024

Medicare Trust Fund Extends Solvency Another 5 Years

Laura Joszt, MA

The Medicare trust fund is now expected to deplete in 2036, with the Inflation Reduction Act being credited for at least some of the extension.

Health care costs | Image credit: Valeri Luzina - stock.adobe.com

May 3rd 2024

Study: ACO Leaders Share Priorities, Challenges in Medicare Shared Savings Program

Leaders at 49 accountable care organizations (ACOs) shared their perspectives on the Medicare Shared Savings Program, as well as a range of strategies for success and ongoing challenges.

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