Payers

With more than 3000 gene therapies in development, payers will have to grapple with the challenges of paying for these innovative but expensive therapies.

Sessions, posters, and late-breaking trials at the American College of Cardiology’s 70th Scientific Session offer updates on vericiguat, SGLT2 inhibitors, sacubitril/valsartan, and heart failure therapies still in the pipeline.

Two posters presented at Virtual ISPOR 2021 analyzed the health care resource utilization and cost of patients with chronic obstructive pulmonary disease (COPD) with pneumonia, as well as the cost savings of treating patients with frequent or severe COPD exacerbations with a fixed-dose triple therapy.

The COVID-19 pandemic brought together the world and taught health systems how to be resilient and adapt to both predictable and unpredictable changes, said the panelists during the plenary on day 1 of Virtual ISPOR 2021.

Two top cardiologists debated evidence involving one clinical trial for omega-3 fatty acids, with implications for another, the REDUCE-IT study for icosapent ethyl (Vascepa).

Results presented at the American College of Cardiology's 70th Scientific Session show most patients prefer a smaller dose and are more likely to stick with it.

When patients had the option of using prescription digital therapeutics, their insurers and employers saved significant money in both direct and indirect medical costs, the 2 studies found.

The 4-day annual meeting of ISPOR—The Professional Society for Health Economics and Outcomes Research—will cover a wide range of topics. Here are 5 themes to keep an eye out for.

Policy makers and health plans seek value-based management of specialty drugs. This study examines real-world factors that favor some approaches over others and their potential impact.

This study evaluates the cost-effectiveness and budget impact to US payers of point-of-care nucleic acid amplification tests (NAAT) for group A streptococcus.

On this episode of Managed Care Cast, Patricia Salber, MD, MBA, of The Doctor Weighs In, talks with the founder and CEO of ConsejoSano, a patient engagement firm working with diverse, multicultural, multilingual populations about the importance of building relationships and trust when trying to understand opinions and beliefs about COVID-19 vaccination.

Although most Medicare Part D plans cover guideline-recommended outpatient chronic obstructive pulmonary disease (COPD) inhalers, the utilization controls applied to these therapies vary by plan type.

Dupilumab is effective for atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyps, but a recent presentation noted the payer challenge in placing the biologic in an optimal tier.

William Shrank, MD, MSHS, the chief medical officer of Humana, discusses how the company is trying to overcome any vaccine hesitancy both in its workforce and in its insured member population.

A novel prediction model is developed that accurately predicts preterm birth in a timely manner among pregnant women in Medicaid without preterm-birth history.

In a review of literature published since the Affordable Care Act’s passage, more than half of analyses find that Medicare Advantage outperforms traditional Medicare on quality, health, and cost outcomes.

Alberta, Canada becomes the latest province to begin switching patients from originator adalimumab (Humira) to biosimilar versions as part of its Biosimilars Initiative.

Robin Gelburd, JD, president of FAIR Health, discusses the sudden decline in telehealth utilization during the first month of 2021.

Posters from the Academy of Managed Care Pharmacy annual meeting evaluated real-world evidence on adherence to biosimilars and barriers to biosimilar adoption.

Quantifying the return on investment came up for both those implementing an oncology care pathway (as a potential barrier) as well as for payers still not convinced it is a way to go.

Unsurprisingly, the use of telemedicine grew exponentially during the COVID-19 pandemic, but those changes are not here to stay without major policy changes, according to speakers at the American Academy of Dermatology Virtual Meeting Experience 2021.

With the costs of biologic drugs increasing, biosimilars have emerged as an attractive option for containing costs and expanding access to treatment. However, some barriers to wider uptake still need to be addressed, according to a presentation at the National Association of Managed Care Physicians Virtual Spring Managed Care Forum.

While the introduction of sodium glucose co-transporter 2 (SGLT2) inhibitors has benefitted patients with type 2 diabetes and impacted guidelines globally, these expensive therapies have managed care implications, explained Richard E. Pratley, MD, of AdventHealth Diabetes Institute and Johns Hopkins University School of Medicine.

Mitigating the burden of HIV in the United States means taking a more comprehensive approach to diagnosis, testing, and treatment of the disease, said a speaker at the National Association of Managed Care Physicians Virtual Spring Managed Care Forum.

At a session at the National Association of Managed Care Physicians Virtual Spring Managed Care Forum, an Aetna executive discussed how one employer used the payer's data to see how its workforce was affected by social determinants of health (SDOH).

For Alberta and Green Shield Canada, savings are beginning to add up from switching initiatives for multiple reference biologics.

Microsoft's acquisition of Nuance reflects health care trends of an economy emerging from COVID-19, according to a speaker at the National Association of Managed Care Physicians Virtual Spring Managed Care Forum.

To be sustainable and successful, Medicare alternative payment models (APMs) have to attract and retain high and low performers. That requires a different approach to pricing and evaluation.

On this episode of Managed Care Cast, we speak with the chief strategy officer for Well Being Trust, one of the authors of a recent report about how well health insurers and state Medicaid programs are covering mental health care for children and compliance with federal law. We discuss the unique challenges that youth face, the health disparities, racism, and community trauma that has been experienced in the past year, and some creative ways that organizations and communities can consider increase access to mental health supports.