Payers

Although the Oncology Care Model (OCM) is ending June 30, 2022, it does not mean practices can turn back the clock and revert to how they provided care prior to the OCM, explained Debra Patt, MD, PhD, MBA, executive vice president of Texas Oncology.

Panelists of an AHIP 2022 session discussed how future policy, infrastructure, and investment strategies in public health will reinforce the efforts already made during the pandemic, with partnerships and engagement key to optimize innovation.

Abstracts presented at the American Society of Clinical Oncology Annual Meeting evaluated biosimilar use in practices participating in the Oncology Care Model (OCM) and estimated the savings as a result of substituting these agents for more expensive reference products.

The authors modeled a version of the Patient and Caregiver Support for Serious Illness alternative reimbursement structure for palliative care using data from the Statin Trial.

Recommendations discuss appropriate use and diagnostic, prognostic, and therapeutic implications of cardiac genetic testing, including guidance on impact of exercise.

Imposing a surcharge on unvaccinated employees will require employers to think through legal and policy implications.

This scoping review found 350 articles that discuss US health insurance providers’ use of patient-reported outcomes about health-related quality of life.

As part of the Biosimilars Initiative, British Columbia, Canada, implemented a mandatory switch to biosimilar insulin glargine for patients covered by the province’s drug plan.

The Supreme Court has ruled that HHS' decision to lower reimbursement rates to hospitals so that those in the 340B program received reduced rates because they received discounted drugs was unlawful.

Influenza vaccine uptake improved among Medicare Advantage enrollees when influenza vaccination was introduced as a performance metric in Medicare star ratings and accompanying bonus payments.

In a panel discussion, “Banner|Aetna: Collaboration as a Business Imperative,” part of the Matters in Managed Care webinar series, panelists discussed how payers and providers can work as partners to deliver care with aligned financial interests.

Real-world studies evaluating the safety and efficacy of switching to adalimumab biosimilars from the originator product confirmed the safety and efficacy of the biosimilars ABP 501 and SB5.

The analysis of adults with low income enrolled in Medicare Advantage (MA) or traditional Medicare (TM) indicates that increasing enrollment in MA may not advance health equity in the Medicare program.

The Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model provides the next great opportunity in moving a health care payment system toward paying for value and rewarding preventive care and keeping patients healthy.

Medicaid managed care network adequacy standards exhibit significant heterogeneity across regions and specialties, potentially creating large variations in health care access and quality.

As part of its inquiry, the Federal Trade Commission (FTC) will demand that the 6 largest pharmacy benefit managers (PBMs) submit records and answer questions regarding their business practices.

Research presented at EULAR 2022 demonstrated the pharmacokinetic equivalence of a low-concentration version of the adalimumab biosimilar SB5 and a high-concentration version.

Surveys of patients and oncologists found discrepancies between patient experiences and oncologist perceptions of those experiences during a nonmedical switch to trastuzumab biosimilars.

The organizations that can take on 2-sided risk are usually bigger and that’s not always better for health care, said Jayson Slotnik, partner, Health Policy Strategies, Inc.

Alignment of incentives in the United States do not always support the use of biosimilars or other lower-cost alternatives, said Sonia T. Oskouei, PharmD, BCMAS, DPLA, vice president of biosimilars at Cardinal Health.

Data to be presented next week during the American Society of Clinical Oncology Annual Meeting show that for every 10% increase in public welfare spending, there was a 4.55% narrowing of the 5-year overall survival (OS) disparity between Black and White patients with cancer.

As biosimilar competition heats up in the United States, payers have more tools at their disposal to manage these agents.

Many payers are not familiar with digital therapeutics, indicating the need for better education among payers, said Jayne Hornung, chief clinical officer, pharmacy, MMIT.

Thanks to flexibilities provided by the American Rescue Plan, 4 states announced Wednesday they will expand Medicaid coverage to 12 months postpartum, joining others who have already adopted similar measures.

The findings highlight the significant financial burden of sickle cell disease.

The tools we need to achieve long-term stability for community providers and ensure better outcomes for rural Americans are available, and CMS can help us utilize them.

Across commercial insurance, Medicare, and Medicaid populations, oncology is the top category of spend, and the drug pipeline has increasing specific and complex therapies.

The report details totals paid to hospitals by private insurers and providers and compares the sums with a Medicare benchmark.

While 2023 is a big year with at least 7 adalimumab biosimilars expected to come to market, 2024 will be even more important because all the products will be on the market and formulary decisions can be made, said Sonia T. Oskouei, PharmD, BCMAS, DPLA, vice president of biosimilars at Cardinal Health.

Gene therapies in the pipeline to treat hemophilia will be very expensive, but they also seem to be very efficacious, and multiple could hit the market between now and 2024, said Ray Tancredi, RPh, MBA, CSP, divisional vice president, specialty pharmacy development and brand Rx/vaccine purchasing, Walgreens.