Payers

The Greater Philadelphia Business Coalition on Health webinar series provided an in-depth framework for the advantages of including cell and gene therapy coverage in employer health plans, as well as the challenges brought by manufacturing complexities and the need to address accessibility to treatment.

The 2025 Physician Fee Schedule includes a conversion factor reduction, expanded behavioral health services, extended telehealth waivers, new Quality Payment Program pathways, and measures to address suspect billing, alongside a Biden administration initiative introducing federal maternal health standards for hospitals.

After evaluating the association between the expanded Medicare Advantage supplemental benefits and plan composition, authors determined that adoption was not associated with large demographic shifts in enrollment.

Beneficiaries who switched from traditional Medicare to a Medicare Advantage plan experienced no additional protection from medical costs compared with those who stayed in a traditional Medicare plan.

The FDA today approved efgartigimod alfa and hyaluronidase-qvfc for the treatment of adult patients with chronic inflammatory demyelinating polyneuropathy (CIDP).

Ali Khawar, principal deputy assistant secretary with the Employee Benefits Security Administration (EBSA), US Department of Labor, explains how the Mental Health Parity and Addiction Equity Act (MHPAEA) aims to address the mental health crisis in the US.

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.

This study quantified the trends over time in utilization of, spending on, and access to CT fractional flow reserve, the first artificial intelligence (AI)–enabled clinical software reimbursed by Medicare.

A new program from Optum Rx would offer greater predictability by using a guarantee-based pricing model.

The FDA approved the first 2 biosimilars referencing aflibercept (Eylea). However, patent litigation has left it unclear when the biosimilars will come to market.

Pembrolizumab has existing indications in endometrial cancer.

Some experts believe offering a subcutaneous version of nivolumab could make PD-1 inhibitors available to new groups of patients who currently lack access, such as those in rural areas.

The Inflation Reduction Act (IRA) has potential to shift incentives for drug manufacturers and impact the amount of long-term evidence generated for approved drugs, said Julie Patterson, PharmD, PhD, senior director of research at the National Pharmaceutical Council.

With more therapies available in bladder, kidney, and prostate cancers, collaboration among health care providers can help ensure patients are getting the most appropriate care for their type and stage of cancer, said Mary Dunn, MSN, NP-C, OCN, RN, of University of North Carolina.

In 2024, the Asembia Specialty Pharmacy Summit celebrated 20 years and speakers highlighted the conversations around improving access and affordability taking place at the meeting.

Type 1 diabetes (T1D), which once predominantly affected children, is increasingly affecting older adults in the US, with prevalence rates peaking in those aged 45 to 64, according to recent research.

About 5000 leaders in health economics and outcomes research will gather for the 2024 meeting, which has the theme, "HEOR: A Transformative Force for Whole Health.”

While the novel payment models for expensive cell and gene therapies have been effective, they need to continue evolving, said Joe DePinto, MBA, of McKesson.

There are multiple levers that need to be pulled to allow biosimilars to come to market more broadly in the US, explained Fran Gregory, PharmD, MBA, vice president of emerging therapies, Cardinal Health.

The real-time monitoring of patients through medically integrated dispensing (MID) programs can reduce costs of care and remove barriers, said Christie Smith, PharmD, MBA, vice president, pharmacy and payer strategy, Cencora.

Researchers also estimated that more than 700,000 Americans with diabetes could lose insurance coverage if these proposed retractions are put into place, with some new policies already in effect.

Payer coverage of biosimilars is always shifting as new ones come to market, explained Tasmina Hydery, PharmD, MBA, BCGP, associate director in digital solutions, Cencora.

News from Strategic Alliance Partners of The American Journal of Managed Care.

By prioritizing well-being, both the public and private sectors can come together in partnerships to address social needs and social determinants of health.

The introduction of momelotinib to treat myelofibrosis with anemia can result in small savings due to reduced transfusion-related costs, according to a budget impact model.

The new playbook details voluntary best practices for value-based care (VBC) payment arrangements and is part of an effort to increase VBC adoption in the private sector.