Payers

CMS proposed rulemaking Thursday that would pass pharmaceutical price concessions to beneficiaries in Medicare Part D plans and make the medical loss ratio in Medicare Advantage plans more robust.

On this episode of Managed Care Cast, we bring you part 1 of an 8-part video conversation with Blue Cross Blue Shield of North Carolina and Newton Family Physicians about how they adapted to deliver health care in 2020 and 2021.

Projected savings from biosimilars from 2021 to 2025 were $38.4 billion vs conditions as of quarter 4 of 2020 and were driven by new biosimilar entry. Savings were $124.5 billion under an upper-bound scenario.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 8.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 7.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 5.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 5.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 4.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 3.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 2.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 1.

Megan Olsen, MPH, principal at Avalere, discusses the role that value assessments are expected to play in the future pricing of gene and cell therapies.

The most-read AJAC papers of 2021 analyze real-world programs to transform health care and provide insight into physician perspectives of health care and insurance.

Despite being the seventh adalimumab biosimilar approved in the United States, there are none on the market yet.

Readers were most interested in articles about cost of therapy, drug efficacy, and a unique case related to COVID-19.

This year’s most-read articles on Medicare covered topics including accountable care organizations, value-based payment, and star ratings.

Kimberly Westrich, MA, vice president of health services research at the National Pharmaceutical Council, discusses value-based benefit design strategies for high-deductible health plans.

Key opinion leaders discuss the state of mental health in the US workforce, persistent unmet needs, and efforts to improve coverage and uptake of behavioral health services.

Although the pandemic continued to rule health care headlines, a few other stories were noteworthy in 2021 for the AJMC.com audience, including articles about a wider indication for the glucagon-like peptide-1 receptor agonist semaglutide and the heart failure drug Entresto.

This year’s most-read articles on pulmonary arterial hypertension (PAH) covered a range of topics, including nutrition, therapy switches, and patient education to improve treatment adherence. Improving patient outcomes is something they all had in common.

David R. Stukus, MD, FACAAI, of Nationwide Children's Hospital and The Ohio State University College of Medicine, and a board member of the American College of Allergy, Asthma & Immunology, speaks on the difficulties of gaining coverage for newer biologic therapies in the treatment of atopic dermatitis.

This year the United States only approved 2 biosimilars, but the FDA did grant interchangeable status to the first biosimilar.

Experts from Optum, WellMed, and Reliant discuss strategies for bringing value-based payment into specialty care through the use of education and analytics.

Experts from Optum, WellMed, and Reliant discuss strategies for bringing value-based payment into specialty care through the use of education and analytics.

Experts from Optum, WellMed, and Reliant discuss strategies for bringing value-based payment into specialty care through the use of education and analytics.

Experts from Optum, WellMed, and Reliant discuss strategies for bringing value-based payment into specialty care through the use of education and analytics.

Experts from Optum, WellMed, and Reliant discuss strategies for bringing value-based payment into specialty care through the use of education and analytics.

Jeffrey Patton, MD, is the CEO of OneOncology, a national partnership of independent community oncologists based in Nashville, Tennessee. He is also executive chairman of the board, Tennessee Oncology, and a member of the board, Community Oncology Alliance.

Vertical integration of payers and pharmacy benefit managers (PBMs) took flight with the mergers of Aetna and CVS Health and of Cigna and ExpressScripts. Panelists at Patient-Centered Oncology Care® said the shift has filtered down to affect access at the practice level.