Payers

Key social determinants affecting MDD are evaluated by Michael Rothrock, MBA, MHA, and H. Eric Cannon, PharmD, FAMCP.

Expert panelists explore prevalence and disparities of MDD across patient populations.

A survey conducted by the Health Care Payment Learning and Action Network found that “more plans are using incentives in value-based care arrangements to improve health equity.”

Joseph Alvarnas, MD, vice president of government affairs at City of Hope and chief clinical adviser of AccessHope in Duarte, California, spoke on the influence that the California Cancer Care Equity Act is having on legislative efforts in other states, as well as future steps to promote accessible, affordable, and effective cancer care for patients nationwide.

A bill introduced by Senator Mike Lee, R-Utah, would prohibit the FDA requiring switching studies for biosimilars to gain interchangeability status.

Patients with Medicare Advantage (MA) were 1.5 times more likely to die within a month of surgical removal of their stomach or liver, and twice as likely to die within a month of oncologic surgery of the pancreas, compared with patients with traditional Medicare.

Michael Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions (National Alliance), discussed findings of the survey that was presented at the National Alliance 2022 Annual Forum and what concerns employers and business coalitions had regarding the current state of health care cost, delivery, and coverage.

Former Obama administration official Kavita Patel, MD, MS, told a gathering of the OneOncology Physician Leadership Conference that policy leaders and members of Congress need input on the realities of oncology practice finances.

While those with Medicaid insurance were more likely to have an insurance transition before or after giving birth, those with private insurance were also found to have insurance changes.

With multiple biosimilars approved for a reference product and different payers preferring particular products, communication between the clinical pharmacy team and the managed care team is crucial, said Timothy Murphy, MD, FACP, medical oncologist/hematologist with Rocky Mountain Cancer Centers.

The OneOncology Annual Conference is being held November 11-13 in Nashville, Tennessee, and brings together practice leaders, physicians, and advanced practice providers to discuss the business of oncology and scientific advancements, explained Davey Daniel, MD, chief medical officer of OneOncology.

The Department of Veterans Affairs (VA) will give cancer claims priority when a new law takes effect in January 2023; Pfizer is looking to use its COVID-19 profits to grow other blockbusters; the probable loss of Medicaid coverage for millions next year is setting off debate.

Daniel E. Weiner, MD, MS, board certified nephrologist and lead navigator at Tufts Clinical and Translational Science Institute, spoke on the limitations and future potential of value-based payment systems for chronic kidney disease (CKD), including the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model and the Kidney Care Choices (KCC) Models.

It has been 3 years since new kidney care payment models were announced by HHS, and at a session at Kidney Week 2022, the associate division director of nephrology at the University of Alabama at Birmingham described his organization’s participation in Kidney Care First, one of the value-based care models announced in 2019.

Ahead of the big wave of adalimumab biosimilars launching in the US market in 2023, rheumatologists report growing confidence in using biosimilars but remain concerned about their efficacy and economic benefit.

The 2023 Physician Fee Schedule final rule was released and swiftly drew condemnations from physician leaders because of a 4.5% cut to reimbursement.

Brian Corvino, MBA, managing director, Life Sciences and Health Care Practice, Deloitte Consulting, LLP, offered an overview of how the surge of innovation in oncology—and resulting drug approvals—dominate the biopharmaceutical sector. He spoke at the Community Oncology Alliance's Payer Exchange Summit.

The quest to deliver better cancer care—with better outcomes and patient experience—is not a one-size-fits-all journey, as seen in panels during the Community Oncology Alliance (COA) Payer Exchange Summit, held in Tyson’s Corner, Virginia.

In an interview, the section chief of hepatology at Rush University Medical Center discussed why the addition of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code K76.82 is necessary.

The FDA’s approval of teclistamab for relapsed/refractory (R/R) multiple myeloma makes it the first bispecific T-cell engager antibody to enter the treatment landscape.

Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento, discussed how prior authorizations and other insurance requirements are limiting treatment access in atopic dermatitis and how dermatologists can help ameliorate these approval issues.

Black and Latino Americans saw surges in health care insurance enrollment through the Affordable Care Act (ACA) between 2020 and 2022; Medicaid enrollment and spending is expected to slow in 2023; the Biden administration is preparing a national hepatitis C treatment plan.

The latest updates in lung cancer screening guidelines will help address disparities in certain populations, but multiple barriers including access to programs and payer coverage remain issues.

Results will be presented at an upcoming medical conference.

Biosimilars have had such an impact on driving down costs, that in some instances the reference product might be the lowest cost option, explained Paul Forsberg, PharmD, director of pharmacy, Minnesota Oncology.