Payers

Medicare Part B drug negotiations in 2028 pose challenges for providers, requiring new payment systems and strategies to ensure patient access, explained H. John Beardsley, MBA, of CoverMyMeds, and Fauzea Hussain, MPH, of McKesson.

A score was developed to measure patient risk from payer utilization management policies and its relationship to real-world US commercial payer utilization management policies.

Payers should consider providing higher reimbursement rates and/or preferred pharmacy networking status for pharmacies that provide chronic medications in blister packs for patients.

Delandistrogene moxeparvovec, a gene therapy for Duchenne muscular dystrophy (DMD), showed high dystrophin expression and a favorable safety profile in young patients.

Despite holding promise in a range of disease states, a variety of challenges prevent cell and gene therapies (CGTs) from more widespread use, according to a new report from Cardinal Health.

Delandistrogene moxeparvovec (Elevidys; Sarepta Therapeutics) appeared to protect muscle from progressive damage in patients with Duchenne muscular dystrophy (DMD) based on muscle quantitative magnetic resonance measures.

Covered California and Health Net’s novel data exchange initiative significantly improved quality measurement and potentially reduced costs by more than $640,000.

Physician groups under 2-sided risk–based Medicare Advantage provide care associated with higher quality and efficiency compared with care by these same groups under fee-for-service Medicare.

Innovative financing and reimbursement models can improve access to cell and gene therapies, addressing cost barriers and improving patient outcomes, said Joe DePinto, MBA, of McKesson.

Pieter Sonneveld, MD, PhD, chair of the Erasmus MC Cancer Institute, discussed the findings of a study modeling long-term progression-free survival (PFS) in patients with multiple myeloma (MM) treated with a daratumumab quadruplet regimen.

To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes reflections from a thought leader on what has changed over the past 3 decades and what’s next for managed care. The May issue features a conversation with John Michael O’Brien, PharmD, MPH, a member of AJMC’s editorial board and the president and CEO of the National Pharmaceutical Council. This interview has been lightly edited for clarity.

Approximately 1 million Aetna members will need new coverage with the announcement that CVS will be leaving the Affordable Care Act (ACA) individual exchange business next year.

The results offer some of the first glimpses into real-world findings of the Janus kinase inhibitor in patients with myelofibrosis (MF) and anemia.

As the number of cell and gene therapies expands, it's increasingly important for long-term patient data, explained Fran Gregory, PharmD, MBA, vice president of emerging therapies at Cardinal Health.

As drug denials increase, experts discuss the importance of optimizing data to keep up with these changes and implementing artificial intelligence (AI) to reduce the burden on providers and ensure patient access to care and treatment.

Progression-free survival improvement and drug costs make zanubrutinib a more cost-effective option in relapsed or refractory chronic lymphocytic leukemia (CLL), new research suggests.

None of the eteplirsen-treated patients reached a left ventricular ejection fraction below 50% compared with 22.1% of patients in the control group.

The California-based entities plan to offer new Medicare Advantage (MA) products in select counties by this fall.

Investigators highlighted Raman spectroscopy, a noninvasive diagnostic technology that could lead to faster, earlier detection of skin cancer.

Researchers warned that to achieve such reductions, greater uptake of the medication among indicated patients is needed.

This study examined postdiagnosis breast cancer treatment outcomes for Medicare Advantage vs fee-for-service (FFS) Medicare in Ohio and found no significant differences overall but disparities for Black patients with FFS Medicare.

Prior authorizations create substantial administrative and financial burdens on physicians and patients and can disrupt the continuity of care.

A real-world analysis showed a link between continuous glucose monitor (CGM) distribution channel and outcomes for patients with diabetes.

The approval of revakinagene taroretcel (Encelto; Neurotech) addresses a significant unmet need for patients with macular telangiectasia type 2 (MacTel), clinical investigator Charles C. Wykoff, MD, PhD, Retinal Consultants of Texas, said.

Resmetirom offers a targeted approach to metabolic dysfunction–associated steatohepatitis (MASH) for use alongside lifestyle modifications.