Payers

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.

Panelists at an Academy of Managed Care Pharmacy (AMCP) Nexus 2022 session discussed enhanced utilization management strategies to manage the rising cost of specialty drugs, while providing members with support for rare, complex conditions.

The concluding keynote address at the Academy of Managed Care Pharmacy Nexus 2022 meeting discussed new and emerging oncology drugs in the pipeline and their potential impact on the treatment landscape as it pertains to managed care providers.

Mike Koroscik, vice president, Oncology, Allina Health Cancer Institute, presented “Preparing for Population Health in Oncology,” during the Association of Community Cancer Centers 39th National Oncology Conference, which concluded Friday.

While a majority of national lives are covered by vertically integrated insurers, the proportion varies widely at the state level from as low as 6% to as high as 97% of covered lives, according to a new American Medical Association (AMA) report about competition in the pharmacy benefit manager (PBM) sector and insurance.

New and emerging medications in the specialty drug pipeline were discussed during a keynote address at AMCP Nexus 2022 by Aimee Tharaldson, PhD, senior clinical pharmacist of emerging therapeutics at Express Scripts, with biosimilars, orphan drugs, and cell and gene therapies emerging as key trends to watch.

Two stakeholders from Avalere Health discuss the utility of patient-centric value frameworks for equitable health care delivery, as well as challenges and strategies regarding its implementation at Academy of Managed Care Pharmacy Nexus 2022.

Even though there is a 1-year gap between the Oncology Care Model and the Enhancing Oncology Model, there remain value-based oncology payment programs with private payers, said Glenn Balasky, executive director of Rocky Mountain Cancer Centers.