Payers

Comparing plans with similar characteristics, such as size, geographic location, or demographics served, allows for more meaningful insights and improvement opportunities.

On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.

Cell and gene therapies can be life-changing for patients with certain conditions, but the process of receiving them poses barriers for patients and caregivers that require multistakeholder solutions, according to a white paper from the National Pharmaceutical Council.

In an interview, Debra Patt, MD, PhD, MBA, FASCO, discusses the priorities of the Community Oncology Alliance as she starts her term as president.

Two new measures tied to outcomes drawn from data in the CLEAR phase 3 trial will be presented during the ASCO Genitourinary Cancers Symposium later this week in San Francisco, California.

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

Mikkael A. Sekeres, MD, Sylvester Comprehensive Cancer Center, discusses the potential benefits of treosulfan, a newly approved agent for allogeneic hematopoietic stem cell transplantation (allo-HSCT) conditioning in acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS).

Relying on veteran survey responses and novel actuarial data, the authors examine the relationship between benefit value and reliance on the Veterans Health Administration.

World Cancer Day also marks the start of the ‘United by Unique’ campaign, which seeks to highlight how each person’s journey with cancer is unique, even though the patients, caregivers, and health care teams who are touched by cancer are united by shared goals.

Amid the uproar over the firing of 18 inspectors general, a report offering a coda to the aducanumab approval episode has been overlooked. It shows the need for reforms of the FDA's accelerated approval process.

The high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.

Semaglutide (Ozempic) is 1 of 15 medications that will be included in yearly price negotiations between Medicare and manufacturers.

Altruism values for treatments of rare, severe pediatric diseases have not been estimated. This study found the altruism value for a hypothetical new Duchenne muscular dystrophy treatment to be $80 per year.

If the subcutaneous delivery method gains approval, an advantage daratumumab holds over isatuximab would be removed.

The authors used medical loss ratio forms to assess trends in premiums, medical claims, administrative costs, quality improvement, and margins in the large group insurer market.

Data from a systematic review of 30 real-world studies show comparable discontinuation rates of ocrelizumab to those in pivotal clinical trials among patients with different types of multiple sclerosis (MS).

The most-read obesity articles of 2024 mostly focused on insurance coverage of weight loss medications and costs.

The Wellness Way facility was designed to improve access to comprehensive outpatient care and address social determinants of health for a diverse patient population.

Coverage from the IVBM Regional event in Denver, Colorado.

Payers and employers have tightened access to the glucagon-like peptide 1 receptor agonist class once these therapies became more commonly prescribed for obesity.

Over time, biosimilars are gaining traction in the US and becoming preferred products, explained James D. Chambers, PhD, of Tufts Medical Center.

Lindsay Bealor Greenleaf, JD, MBA, of ADVI Health, weighs in on what to expect in key health care policy areas in the wake of the election.

Authors found the pharmacy costs for momelotinib were $11,095 higher per month, too much to offset higher transfusion costs for ruxolitinib.