Payers

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

On this episode of Managed Care Cast, we speak with one of the authors of a paper published this month in Health Affairs about the utilization of substance use disorder treatment (SUD) services between 2010 and 2019, and why more needs to be done to get more individuals into treatment.

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.

While CMS has started making changes to address health equity through policy and payment models, commercial plans are waiting to see the outcomes before they follow suit, said Jayson Slotnik, partner, Health Policy Strategies, Inc.

Experts evaluated the future of cell and gene therapies in the United States and offered insights on potential value-based payment models for these treatments.

Biosimilar adoption can be accelerated or stymied depending on actions taken by the managed care space, explained Sonia Oskouei, PharmD, vice president, biosimilars, Cardinal Health, during a session at Asembia’s Specialty Pharmacy Summit.

In a session at the 2022 Asembia Specialty Pharmacy Summit, Jayne Hornung, chief clinical officer at Managed Markets Insights & Technology (MMIT), outlined factors driving payer hesitation when it comes to covering prescription digital therapeutics.

UPMC Health Plan, RxAnte, and Mosaic Pharmacy Services outlined how they are operating a value-based pharmacy care management program within Community HealthChoices, Pennsylvania’s managed Medicaid long-term services and supports (LTSS) program, at a recent conference.

Experts from The US Oncology Network discuss the future of value-based cancer care, and what practices can do as the Oncology Care Model expires.

Experts from The US Oncology Network discuss the future of value-based cancer care, and what practices can do as the Oncology Care Model expires.

Experts from The US Oncology Network discuss the future of value-based cancer care, and what practices can do as the Oncology Care Model expires.

Experts from The US Oncology Network discuss the future of value-based cancer care, and what practices can do as the Oncology Care Model expires.

Coverage, equity, and value-based payments are critical areas of focus for the Biden administration’s health care agenda leading up to the midterm elections, according to 3 experts from Avalere.

Addressing rural care is a way of addressing health inequities, and the Biden administration’s recent investment in rural care reflects its commitment to addressing health equity, said Ryan Urgo, MPAP, managing director, health policy, Avalere.

At the Pharmacy Quality Alliance (PQA) 2022 Annual Meeting Wednesday, participants heard about some unexpected insights arising from a workshop held this week between patients and pharmacists who are creating a patient-centered outcomes research agenda focused on addressing social determinants of health (SDOH) in the community pharmacy setting.

Adam Fein, PhD, of Drug Channels Institute, and Doug Long of IQVIA discussed trends in the specialty pharmacy market in the United States.

Representatives from employers, pharmacy benefit managers, and others discussed methods of improving pharmacy access and affordability in health plans.

Value-based payments were a benefit during the pandemic, but it remains to be seen if patients are interested in keeping those changes in care delivery as the pandemic recedes, said Jayson Slotnik, partner, Health Policy Strategies, Inc.

There are several pieces of legislation that could have an impact on drug rebates, explained Tracy Russell, senior director, government affairs, CoverMyMeds.

The approval of aducanumab (Aduhelm) was very controversial. There are 3 promising Alzheimer disease drugs in the pipeline with trials evaluating the efficacy, and there is a huge unmet need for these therapies, said Ray Tancredi, RPh, MBA, CSP, divisional vice president, specialty pharmacy development and brand Rx/vaccine purchasing, Walgreens.

Not only did a majority of each group say they hadn’t heard of biosimilars, but those who had heard of them had negative perceptions.

Patricia Deverka, MD, MS, senior researcher, deputy director at the Center for Translational and Policy Research and Precision Medicine, University of California San Francisco, explains what multicancer early detection tests currently exist and the research needed to understand their clinical utility.

The opening plenary of the Spring 2022 National Association of Accountable Care Organizations conference focused on addressing health equity and improving synergy between CMS and ACOs.