Payers

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.

The accountable care organizations (ACOs) participating in the new ACO REACH model will have a health equity benchmark adjustment and need to collect more data to help better understand the populations being cared for and serve those from underserved communities, said Michael Chernew, PhD.

The study by the Veneto Institute of Oncology (IOV) in Padua, Italy, examined 286 patients for genomic mutations in cholangiocarcinoma as well as survival status.

A comparison of type 2 biologics indicated for the treatment of chronic rhinosinusitis with nasal polyps identified dupilumab as the most effective drug in decreasing nasal polyp score and nasal congestion severity, whereas benralizumab was least effective.

Robert Sidbury, MD, MPH, chief, Division of Dermatology, Seattle Children's Hospital, spoke on considerations for dermatologists in seeking payer coverage of novel, expensive therapies for atopic dermatitis.

The annual spring meeting of AMCP 2022 will include keynote sessions on health care and marketplace trends and the specialty pharmaceutical pipeline, with a featured preconference session on bias in health care.

Patients switched from the originator product maintained their clinical outcomes and remissions status while biologic-naïve patients recorded positive responses and remission outcomes after initiating infliximab-dyyb.

Coverage of COVID-19 tests and treatment bills halted for uninsured; Moderna low-dose vaccine in children under 6 years of age shows promise in early clinical trial findings; Pfizer recalls blood pressure medications due to potential carcinogen.