Payers

Joseph Alvarnas, MD, vice president of government affairs at City of Hope and chief clinical adviser of AccessHope in Duarte, California, spoke March 4 at the closing session of the Association for Community Cancer Centers (ACCC) Annual Meeting & Cancer Business Summit in Washington, DC.

Predictive models can help find high-risk patients with asthma and manage them proactively, but prior models miss the highest-risk patients and may mislabel low-risk patients.

Alymsys from Amneal Pharmaceuticals and mAbxience is the third biosimilar referencing Avastin approved in the United States and the second of 3 biosimilar approvals Amneal expects in 2022.

Delayed diagnosis of wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) results in inappropriate treatments prior to diagnosis and worse clinical outcomes after diagnosis.

News on 2 new CAR T-cell therapies and updates on PARP inhibitors, BTK inhibitors, and biosimilars.

Coverage from the Community Oncology Alliance 2022 Community Oncology Conference, held March 17-18 in Kissimmee, Florida.

Across OneOncology, says Edward Arrowsmith MD, MPH, clinical pathways offer a vehicle for physicians to agree on best practices and to implement them across the network. Early this year, Arrowsmith became medical director for Clinical Pathways, OneOncology.

In Medicaid, delivering care needs to address the lack of resources and other socioeconomic factors that impact patients, said Steve Evans, MD, chief medical officer of SilverSummit at Centene.

More than a quarter of patients experience disruptions and delays in treatment for chronic heart failure (CHF) after the initial prescription for sacubitril/valsartan was abandoned/rejected.

Review of CMS’ coverage with evidence development program exposes a need to improve program transparency and clarify requirements and timetables for reporting to improve access to novel therapies.

Without addressing rising costs, the problem of underinsurance in health care coverage will remain, said panelists at the 2022 V-BID Summit, discussing some of the smaller steps that are being proposed or are already in place to try to ease the financial burden.

Despite their intention to protect against coverage denial and/or premium increases, additional state-level Medigap regulations are correlated with lower Medigap enrollment and stronger moral hazard.

Patients who cardiologists see once every few months are getting handed over to pharmacists who can monitor them more frequently and get them to their goals, said Crystal Zhou, PharmD, assistant professor of Clinical Pharmacy at the University of California, San Francisco (UCSF).

Many of the accountable care organization (ACO) models are being tested to find changes to make to the Medicare Shared Savings Program, but there is a general problem with short-lived models ending and being replaced by new ones, said Michael Chernew, PhD.

With more people living with HIV now reaching advanced ages and qualifying for Medicare coverage, this new study investigated HIV-related influences on their health care spending, particularly antiretroviral therapy (ART), compared with a population who does not have HIV.

Many oncologists oppose white bagging because they prefer to be able to adjust doses during a visit based on lab reports taken that day.

Implementing changes in a health system to promote biosimilar adoption is not easy, but by implementing a program, there could be substantial savings.

The clinical effectiveness of chimeric antigen receptor (CAR) T-cell therapies adds a new weapon in the arsenal to treat patients with relapsed and refractory disease; however, they come with access, logistical, and reimbursement challenges that make it difficult to treat all the patients who could benefit.

Value-based contracts are growing as drugs get more expensive and effective, but it’s still an emerging area with a lot of unknown and uncertainty.

In 2022 and 2023, there are a number of big therapies losing patent exclusivity, which opens the door to generics that could save as much as $30 billion.

While the pandemic will have lasting impacts on the US health care market, much of it has bounced back and returned to normal, said Doug Long, MBA, of IQVIA, during the Thursday keynote at the Academy of Managed Care Pharmacy annual meeting.

Although the medication therapy management program in Tennessee's Medicaid population did not reduce costs, some adherence to medication improved and emergency department visits improved.

Racial and ethnic health disparities are documented and substantial, but the data are out there to create programs that successfully address these disparities, said panelists.

An unprecedented level of detail and robustness around interoperability standards is on its way, and on this episode of Managed Care Cast, we speak with Donald Rucker, MD, the former National Coordinator for Health Information Technology in HHS, about what the opportunities and responsibilities for payers are.