Payers

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.

The US could start catching up to Europe on biosimilars if the FDA removed the need for switching studies to be granted interchangeability.

Being married and having insurance can offer emotional support and financial stability to lead to early diagnosis and effective treatment, the authors found.

New legislation would clarify rules around value-based contracts in Medicaid, and a new model is expanding access to gene therapies, explained Adam Colborn, JD, of AMCP.

CMS is creating infrastructure to improve coverage of prescription digital therapeutics (PDTs), and new legislation would also drive uptake of PDTs.

As health care costs escalate, a new survey reveals that 74% of employers are grappling with the impact on employee wages and benefits, with many anticipating further cost-shifting to their workforce.

Stuart Staggs, vice president of transformation and shared services at McKesson, explained that oncology practices in the Enhancing Oncology Model (EOM) have a tough job driving down costs when drug costs make up a larger portion of the total cost of care.

Medicaid, Medicare, and private insurance programs all showed significant variability in expenditures based on social and nonclinical factors.

The Wellth smartphone app significantly increased medication adherence and lowered unnecessary health care utilization and costs over 9 months among Medicaid beneficiaries who were self-managing chronic conditions.

There is a role for both payers and providers to make small changes that would increase the use of biomarker testing to ensure patients are receiving the appropriate treatment, said Susan Wescott, RPh, MBA, senior director of managed care pharmacy, Mayo Clinic.

Co-pay accumulators and maximizers are 2 programs that insurers have started implementing to help them redirect financial assistance from the patient, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.

A review of positions and track records of Vice President Kamala Harris and former President Donald Trump on reproductive health, the future of the Affordable Care Act, prescription drug costs, health care consolidation, and a proposed Medicare home health benefit.

The prevalence rates of metabolic dysfunction–associated steatohepatitis (MASH) and metabolic dysfunction–associated steatotic liver disease (MASLD) are likely underestimated using claims data alone.

As a result of vertical integration, health plans may have 2 different coverage policies on the medical benefit side and the pharmacy benefit side for the same drug.

Although the cost of biomarker testing isn’t cheap, the cost of therapy for patients can be much higher, making it important to conduct these tests to start the right therapy, explained Susan Wescott, RPh, MBA, of Mayo Clinic.

Lalan Wilfong, MD, a 20-year medical oncologist with Texas Oncology, is senior vice president, value-based care, Thyme Care.

An integrated, rule-based informatics system demonstrated its capacity to leverage electronic health records to streamline the prior authorization process and promote the use of biosimilars.