Payers

Accounting for 32% of all Medicare enrollees in 2019, high-need beneficiaries were more likely to be in traditional Medicare than Medicare Advantage.

Mirvetuximab soravtansine-gynx (Elahere) received full FDA approval for the treatment of folate receptor alpha–positive (FRα+), platinum-resistant ovarian cancer (PROC) based on findings from the confirmatory phase 3 MIRASOL trial.

The Duchenne muscular dystrophy (DMD) treatment vamorolone received FDA approval in October 2023 and is a less toxic alternative to conventional corticosteroids.

The FDA has granted accelerated approval to ponatinib (Iclusig) plus chemotherapy for the first-line treatment of Philadelphia chromosome–positive acute lymphoblastic leukemia (Ph+ ALL).

After years of efforts to reduce low-value care, panelists at the 2024 Value-Based Insurance Design Summit proposed a new strategy: drawing a line in the sand that payers will not be on the hook for these services.

As pressure from the Biden administration on UnitedHealth Group increases, physicians' groups weigh in following the unprecedented hack on Change Healthcare.

Over the course of the last 20 years, high-deductible health plans (HDHPs) have undergone an evolution. Today’s plans, with more high-value services covered predeductible, can improve care for people with chronic diseases, said panelists at the 2024 Value-Based Insurance Design (V-BID) Summit.

The author calls on Congress to address reimbursement shortfalls that are contributing to a growing physician shortage, with rural areas the hardest hit.

In his State of the Union Address, the president called for expanding the number of drugs subject to Medicare price negotiations and extending a $2000 out-of-pocket cap beyond seniors.

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.

Getting weight loss drugs into the hands of those who need them could be a matter of changing pricing models to give more patients access to the medication they need.

Starting summer 2024, individuals across the US will be able to purchase a continuous glucose monitor (CGM) without needing a prescription.

Modeling estimates indicate that annual breast cancer screening starting at age 40 years provides the greatest benefit to women and reduces risk per examination.

Out-of-pocket costs of diabetes medications other than insulin can be quite high for individuals with employer-sponsored health insurance.

Payer costs for COVID-19 ranged from a mean of $505 for asymptomatic cases to $126,094 for severe cases with post–COVID-19 condition.

Among a cohort of insured patients with cancer, the median total monthly cost of oral lenvatinib was $17,253, and 75% of patients paid $100 or less out of pocket per month for the drug.

Researchers of the review are underscoring the potential for economic policies to improve the management of hypertension for the millions of people throughout the United States with the condition who are at risk for cardiovascular disease.

An on-body delivery system approved last fall for paroxysmal nocturnal hemoglobinuria (PNH) has seen rapid uptake and is now being studied for use with isatuximab.

Lifileucel was granted approval for the treatment of adults with unresectable or metastatic melanoma that has been previously treated with other therapies, marking the first approval of a tumor-derived cellular therapy in a solid tumor cancer.

This study leverages newly available hospital pricing data to explore hospital-insurer contracts from a large hospital chain.

At an Institute for Value-Based Medicine® event held in Phoenix, Arizona, experts from Banner Health and Aetna discussed how health inequities and social determinants of health can affect primary care in patients with any type of insurance.

Patients enrolled in a preventive drug list (PDL) benefit saw an 8.4% reduction in acute, preventable diabetes complication days, and PDL members residing in lower-income areas saw a 10.2% decrease compared with control members.

UnitedHealthcare is incorporating real-world evidence into pathways design and policy formulation, leveraging its members' data to evaluate the impact of different regimens on health resource utilization and costs, explains Lucy Langer, MD, MSHS, national medical director of oncology and genomics at UnitedHealthcare.

Drug prices in the US increased 4.4% annually and median out-of-pocket (OOP) costs increased 9.6% annually from 2009 to 2018, but there was no direct link between these amounts for individual drugs.

In a systematic review and meta-analysis, real-time continuous glucose monitoring (CGM) demonstrated benefits in terms of time in range, hypoglycemia, and hyperglycemia among patients with type 1 diabetes (T1D).

Findings from PREVENT-HF put to rest the idea that once remodeling in the heart's structure starts following anthracyclines that nothing can be done to treat it.

Based on a comparison of prices for drugs up for Medicare price negotiations, there is a long way to go to reach the prices of 7 comparable countries.

The author, chair of the Government Affairs Committee with the American College of Rheumatology, calls for support for efforts in Congress to reform the Physician Fee Schedule.