Payers

Ted Okon, MBA, executive director of the Community Oncology Alliance, spoke with The American Journal of Managed Care® about how the Federal Trade Commission's (FTC) lawsuit against pharmacy benefit managers (PBMs) could affect the future of pharmaceuticals and oncology.

JT Lew, PharmD, MBA, managed care pharmacist at MultiCare Health System, spoke to the impacts of processes such as prior authorization and step therapy requirements in the realm of multiple sclerosis (MS).

The author discusses a program to prevent kidney decline and progression to dialysis by offering education, support services, and help navigating the health care system to those most at risk.

Ocrelizumab and hyaluronidase is now the first and only twice-yearly subcutaneous injection approved for relapsing multiple sclerosis (RMS) and primary progressive multiple sclerosis (PPMS).

Panelists discussed how the Inflation Reduction Act and the Enhancing Oncology Model are impacting value in cancer care and access to treatment.

During the first fireside chat at the Patient-Centered Oncology Care® meeting, Alyssa Schatz, MSW, of National Comprehensive Cancer Network, discussed work being done to improve care for patients with cancer.

Dax Kurbegov, MD, senior vice president of Sarah Cannon Cancer Network, discussed divides between payers, health systems, and oncology care providers, as well as the impacts these divides can have on patients.

The transition to value-based care is extremely challenging because everyone is also still being paid by fee for service, said Lalan Wilfong, MD, senior vice president, value-based care, Thyme Care.

The findings may help inform policy changes at the federal level aiming to address unfair and deceptive pharmacy benefit manager (PBM) practices.

There are concerns that the negotiated drug prices under the Inflation Reduction Act (IRA) are leading to large provider reimbursement cuts, explained Nick Ferreyros, managing director, Community Oncology Alliance.

Payers must continue to assess their prior authorization practices to uphold the goals of clinical quality, safety, and utilization management.

A comparative analysis investigating time from a drug's approval to insurance reimbursement found that the speed of this process in the US falls behind some European countries.

The disease-modifying treatment landscape has expanded in recent years, but access to the latest approved Duchenne muscular dystrophy (DMD) treatments can be a challenge for patients and providers, Aravindhan Veerapandiyan, MD, a pediatric neuromuscular specialist at Arkansas Children’s Hospital, said.

Katherine Baker, MD, MMHC, of Tennessee Oncology, highlights the need for physician-payer collaboration to tackle challenges and drive innovation in specialty care.

Aetna has become the first major US insurer to expand access to fertility services by covering intrauterine insemination as a medical benefit for all eligible plans, marking a significant move toward greater equity in family-building options for people of all backgrounds.

Celltrion's adalimumab-aaty biosimilar is now accessible for all Costco members, while Amgen sues Samsung Bioepis over the latter’s denosumab biosimilar candidate, and GlycoNex progresses its denosumab biosimilar SPD8 to phase 3 trials.

In this review, authors explain the supply chain issues of getting a life-saving treatment "vein to vein."

A review of the upcoming schedule of the Institute for Value-Based Medicine.

This article first appeared on The Center for Biosimilars®.

The FDA has approved axatilimab-csfr (Niktimvo) for treating adults and children with chronic graft-versus-host disease who have progressed on at least 2 prior treatments.

The immunotherapy combination was initially more costly but resulted in a lower cost of care over a 2-year period, investigators found.

Aravindhan Veerapandiyan, MD, of the Division of Pediatric Neurology at the University of Arkansas for Medical Sciences, discussed the Duchenne muscular dystrophy (DMD) therapy landscape and barriers to treatment access.

Those in minority groups face barriers even after they’ve made the hard decision to seek mental health care. The Department of Labor aims to address systemic issues on a personal level.

The Greater Philadelphia Business Coalition on Health webinar series provided an in-depth framework for the advantages of including cell and gene therapy coverage in employer health plans, as well as the challenges brought by manufacturing complexities and the need to address accessibility to treatment.

The 2025 Physician Fee Schedule includes a conversion factor reduction, expanded behavioral health services, extended telehealth waivers, new Quality Payment Program pathways, and measures to address suspect billing, alongside a Biden administration initiative introducing federal maternal health standards for hospitals.

After evaluating the association between the expanded Medicare Advantage supplemental benefits and plan composition, authors determined that adoption was not associated with large demographic shifts in enrollment.