Payers

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Fatal adverse events (AEs) associated with alemtuzumab for multiple sclerosis (MS) may occur more frequently than previously understood based on past published literature, researchers found.

This week in managed care, the top news included outcomes results in treating heart failure; US prevention experts said more women should get BRCA testing; the American Heart Association offered an advisory on treating high triglycerides with prescription omega-3 fatty acids.

Regeneron released positive phase 3 results for evinacumab, a drug for a rare form of deadly high cholesterol, and said it expects to seek FDA approval in 2020.

Traditionally, migraine is thought of as an issue of lost productivity, but there is evidence that there are direct costs on the medical claims side, said Neil Goldfarb, president and chief executive officer of the Greater Philadelphia Business Group on Health.

Business leaders discuss challenges of providing healthcare to employees and what has changed in the last few years.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Health plans on the Affordable Care Act (ACA) exchanges will be required to display quality ratings starting with the 2020 plan year, according to an announcement from CMS, which is expanding the 5-star rating system it uses on Medicare plans to the health insurance exchanges.

Value-based programs such as accountable care organizations appear to encourage the adoption and spread of care coordination activities by hospitals.

The FDA ordered 4 companies to stop selling 44 of their flavored e-liquid and hookah tobacco products that lack the required approval for sale; CMS has yet to implement a 2014 law preventing unnecessary, expensive screening tests (magnetic resonance imaging, computed tomagraphy scans and other tests) that could harm patients and waste resources; Amarin, which is seeking FDA approval for an expansion of Vascepa labeling to include data that showed a 25% reduction in the risk of heart attacks and strokes, said the FDA has scheduled an advisory committee meeting for November 14.

Nasal glucagon is seen as a game-changing delivery method to replace the multistep system of mixing powder and liquid with a simple, 1-step spray.

Several physician and payer characteristics are associated with physician satisfaction with health plans. There is opportunity to improve physician satisfaction with payers, specifically in pharmacy.

The prices of targeted oncology therapies have grown substantially, but revenues have not. This is due in part to large declines in per-drug patient counts.

The upfront prices of potentially curative therapies are terrifying to commercial payers and government payers alike. A panel on the last day of ISPOR 2019 discussed these issues in a session called, “Is Affordability Driving a Need to Revolutionize Drug Pricing?”

Changing patients from an inhaled corticosteroid (ICS)/long-acting β agonist (LABA) inhaler and long-acting muscarinic agonist (LAMA) inhaler to a LAMA/LABA inhaler and a separate ICS inhaler did not appear to affect patient-reported chronic obstructive pulmonary disease (COPD) symptom scores.

A report from the Health Care Cost Institute examined 4 years' worth of data covering 1.8 billion claims in 112 markets.

We surveyed biopharmaceutical manufacturers and payers to understand the prevalence and characteristics of value-based payment arrangements, as well as their implementation obstacles and success factors.

HHS released 2 long-awaited rules meant to transform how health records and medical claims are delivered and communicated, with one aimed at aggregating electronic health records and claims information into an interoperable mobile format that patients could call up on their devices and another that would require that access to electronic health information come at no cost to the patient and end information blocking.

Research and regulatory gaps in the use of marijuana will only grow unless the scientific community and policy leaders fill the void, according to a commentary series in Annals of Internal Medicine on marijuana’s rising availability.

The year 2019 will finally be when the healthcare industry, particularly payers and providers, finally begins to catch up to other industries in terms of giving the consumer what they want.

A perspective on the current FDA guidance for diabetes therapies.

If the trial is successful, venglustat could be the first treatment to target the mechanism of action in autosomal dominant polycystic kidney disease (PKD), which affects 120,000 people in the United States.

Despite impending changes in Washington, DC, as the Democrats are set to take over the House of Representatives in 2019, the divided federal government could lead to a spell of predictability for some healthcare sectors as most action shifts to the state level.

Pharmacy benefit managers (PBMs) will have to disclose some information about their compensation and relationships with payers.

A coalition of diverse interest groups—payers, unions, and business groups—wrote Senate leaders Monday to express their opposition to the inclusion of “pay for” legislation regarding end-stage renal disease (ESRD) in an opioid bill passed in June by the House of Representatives.

Payers and providers are looking to keep vulnerable patients in pain from becoming addicted to painkillers, but those who live with pain on a daily basis are understandably upset at the thought of losing access to medications they say keep them functional. Here are 5 takeaways from recent coverage about this important issue.

Using the example of low back pain, a study in JAMA Open suggests insurers could help to reduce opioid overuse by expanding access to nonopioid alternatives through improved coverage and reimbursement policies.

Compared with the general population, adults who survive an opioid overdose are 24 times more likely to die during the year after the incident from a variety of mental health and medical conditions, including from substance use–associated diseases and suicide, according to a study published in JAMA Psychiatry.

Authors from Foundation Medicine explain the regulatory path that led to approval of FoundationOne CDx.