Interviews

On this episode of Managed Care Cast, we're talking with the author of a study published in the October 2024 issue of The American Journal of Managed Care® that explored prior authorization decisions in cancer care by race and ethnicity for commercially insured patients.

Robert Lustig, MD, MSL, warns that sugary baby foods, rising birth weights, and ultraprocessed school meals are fueling long-term health risks in children.

Mabel Mardones, MD, board-certified medical oncologist and hematologist who specializes in breast cancer at Rocky Mountain Cancer Centers, emphasizes the importance in identifying patients with HR-positive, HER2-negative (HR+/HER2–) breast cancer with unmet treatment needs.

In addition to Cobenfy being approved for schizophrenia, there are other drugs with novel mechanisms being studied that may mean combination therapies or, at least, more options for patients in the future.

In our conversation with Jeff Giullian, MD, MBA, chief medical officer with DaVita Kidney Care, we dive into 4 important aspects of kidney care: prevention, social support, integrated care, and patient support.

Mei Wei, MD, an oncologist specializing in breast cancer at Huntsman Cancer Institute at the University of Utah, discusses advancements in breast cancer treatment, highlighting CDK4/6 inhibitors and antibody-drug conjugates as promising alternatives to traditional therapies.

While treatment options are evolving cancer care and extending lifespans, there is still a lack of biomarkers in certain cancers that can help direct treatment or provide early detection.

Glenn Balasky, executive director of Rocky Mountain Cancer Centers, emphasizes the need for government support to sustain telehealth and suggested a hybrid model combining centralized high-tech care with remote monitoring to address the challenges of providing innovative care in rural settings.

CMS made improvements for the Enhancing Oncology Model (EOM) over the Oncology Care Model (OCM), but there remains a delay in data and the challenge of high-cost, novel therapies, explained Stuart Staggs, vice president, Transformation and Shared Services, McKesson.

Navdeep Tangri, MD, PhD, FRCP, University of Manitoba, speaks to the value of population health strategies in clinical approaches to care delivery for patients with chronic kidney disease (CKD).

The latest therapy approved to treat chronic graft-versus-host disease (GVHD) has a new target different than the other approved therapies. Daniel Wolff, MD, also discusses future research on axatilimab to treat chronic GVHD earlier.

Hidradenitis suppurativa (HS) is an inflammatory, chronic disease with very high symptom and physical burdens, and it can get progressively worse over time if it's inadequately treated, explained Amit Garg, MD, founding chair, Department of Dermatology, Northwell Health.

The current research focus for Umit Tapan, MD, Boston Medical Center, is reducing disparities in lung cancer care and improving treatment access, in particular for immunotherapy and targeted treatments.

There is a role for both payers and providers to make small changes that would increase the use of biomarker testing to ensure patients are receiving the appropriate treatment, said Susan Wescott, RPh, MBA, senior director of managed care pharmacy, Mayo Clinic.

Co-pay accumulators and maximizers are 2 programs that insurers have started implementing to help them redirect financial assistance from the patient, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.

Seth Southwick, MHA, Intermountain Health, discusses in detail the power of leveraging community partnerships and advanced data analytic systems to optimize kidney care.

A lot of attention has been on the drug price negotiation aspects of the Inflation Reduction Act (IRA), but the implementation of out-of-pocket smoothing is something to keep an eye on, said Adam Colborn, JD, of AMCP.

Bipolar disorder is commonly misdiagnosed depending on the features that present, explained Stephanie Hsia, PharmD, MAEd, BCPP, of University of California, San Francisco.

At our recent Institute for Value-Based Medicine® event in Boston, Hari Deshpande, MD, Yale Cancer Center, presented on predictive biomarkers in sarcomas.

As a result of vertical integration, health plans may have 2 different coverage policies on the medical benefit side and the pharmacy benefit side for the same drug.

Miriam Godwin, CMMI, National Kidney Foundation, touches on the gaps in kidney care that public policy can address, as well as the importance of thinking about the long-term benefits of value-based care.

Patients with schizophrenia have a lot of life-changing consequences when they are being treated properly, and these are only amplified when the patient goes untreated, explained Megan Ehret, PharmD, of University of Maryland, School of Pharmacy.

Schizophrenia may be misdiagnosed as depression or bipolar disorder, which delays treatment and negatively impacts the prognosis, explained Megan Ehret, PharmD, MS, BCPP, of the University of Maryland, School of Pharmacy.

Although the cost of biomarker testing isn’t cheap, the cost of therapy for patients can be much higher, making it important to conduct these tests to start the right therapy, explained Susan Wescott, RPh, MBA, of Mayo Clinic.

There are many misconceptions patients might have about clinical trials that prevent them from participating, and it’s important to understand what they are in order to overcome them, said Terry L. Keys, of University of Kentucky Markey Cancer Center.

Allowing patients to stay in their homes to receive bispecific antibodies can make the whole cancer journey easier, explained Courtney VanHouzen, PharmD, of Cowell Family Cancer Center, Munson Healthcare.

Financial advocacy in health care should advocate for system change and community work to give people better access to health and well-being before they get a life-changing cancer diagnosis, said Nadine J. Barrett, PhD, MA, MS, FACCC, of Wake Forest University and the Association of Cancer Care Centers.

Naoto T. Ueno, MD, PhD, FACP, of the University of Hawai’I Cancer Center outlines the underrepresentation in clinical trials, the lack of permanent medical oncologists, and issues of trust affecting care for the populations living in Hawaii.