Health Care Cost

The designation means that pharmacists can switch patients to the less-expensive version of insulin without seeking approval from the clinician.

In this episode of Managed Care Cast, the lead author of an article in the July issue of The American Journal of Managed Care describes the latest research that looks at the power of self-insured employers to negotiate hospital prices and the relationship between employer market power and hospital prices.

A string of controversies surrounding the approval of Biogen's Alzheimer disease drug aducanumab (Aduhelm) has not only called into question the independent nature of the FDA, but puts both providers and patients in a challenging position when it comes to deciding whether or not to prescribe or take the treatment.

Not all asthma is created equal, nor will all therapies work for all patients. With continued innovations in asthma treatments offering new, improved options for patients, we are more prepared than ever to address uncontrolled asthma head-on.

The measure is designed to end surprise medical billing and balance billing, taking the first step to implement the so-called No Surprises Act that passed Congress at the end of last year.

With systemic health and social inequalities contributing to a lack of health care access and a growing mortality risk among rural Americans, the COVID-19 pandemic has further exacerbated health issues present between community lines. We spotlight several health challenges in these communities and potential solutions to improve the general health of rural populations.

The head of AHIP sat down with a senator and 3 health care executives for a conversation about payment and access issues at the organization's 2021 Institute and Expo Online.

A report from Xcenda showed that biosimilars for 8 blockbuster reference biologics have successfully kept drug prices from increasing by an average of 56%, restoring the possibility that biosimilars could achieve significant discounts despite facing several barriers to uptake.

HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure discussed next steps following the Supreme Court’s decision to uphold the Affordable Care Act (ACA), including continued expansion of Medicaid benefit coverage and addressing disparities in maternal mortality rates nationwide.

In a 7 to 2 decision, the Supreme Court ruled Thursday that the Affordable Care Act (ACA) will stand, as plaintiffs seeking to declare the law unconstitutional did not have standing.

On this episode of Managed Care Cast, we speak with the author of the annual PwC Behind the Numbers report, which looks ahead at medical cost trends in the United States.

Out-of-pocket (OOP) spending for patients with heart failure with reduced ejection fraction rose in the event of a worsening heart failure event across the 4 phases of Medicare Part D coverage.

A new study from Milliman investigated the potential financial impact if H.R.3, the Elijah E. Cummings Lower Drug Costs Now Act, was fully implemented.

United States to buy and donate 500 million COVID-19 vaccine doses to the world; an FDA advisor resigns over a controversial Alzheimer drug approval; Nevada becomes the second state to offer state-managed health insurance plans.

FDA and ASPR issue policy recommendations to reform US pharmaceutical supply chains; insurer coverage implications of the newly approved therapy in Alzheimer disease; Apple announces new health data sharing features.

The researchers created a model that simulated what would happen when health systems and providers began working together in Medicare accountable care organizations (ACOs) in arrangements that did not extend to outright mergers or acquisitions.

The founder of the Renal Support Network discusses why patients with chronic kidney disease want Congress to change Medicare policy to allow payment for oral treatments for anemia caused by iron deficiency.

Davey Daniel, MD, hematology/medical oncology specialist, Tennessee Oncology, discusses findings of an abstract presented at ASCO 2021 showing a lower total cost of care paid by Medicare for episodes of care for patients in the Oncology Care Model (OCM) enrolled in clinical trials vs those receiving routine care.

Stakeholders discuss barriers and solutions to employer engagement on value assessment, which includes redefining goals to that of the employer and patient, and moving beyond the scope of cost and clinical outcomes.

As patients with chronic myeloid leukemia (CML) fail on treatment and move to later lines of therapy, the impact on their health-related quality of life and the economic burden significantly increase.

As awareness of nonalcoholic fatty liver disease (NAFLD) rises, it is essential to develop and implement a rigorously determined approach to identify patients who will, or will not, benefit from diagnostic evaluation.

Deploying vibration-controlled transient elastography/controlled attenuation parameter devices at the population level is a financially advantageous solution to address the epidemic of fatty liver disease.

Patients with acute myeloid leukemia (AML) who relapse after first-line treatment face a substantial health care resource utilization (HCRU) and cost burden, according to a poster presented at Virtual ISPOR 2021.

Patients with sickle cell disease face substantial health care utilization and impaired health-related quality of life (HRQOL).

In 2016, long working hours were associated with 745,000 deaths and 23.3 million disability-adjusted life-years from ischemic heart disease and stroke combined.

Expanded coverage under a Medicare-Medicaid partnership to treat all prevalent cases of hepatitis C appears to be cost-effective by saving money and improving patient outcomes.

Stakeholders identify the value elements of comprehensive genomic profiling (CGP) they find most important, as well as options for innovative contracts.

As the cost of therapies increases, US health plans are utilizing tools like step therapy, to ensure patients try cheaper alternatives first, and value assessment frameworks, to assist with the decision-making process.

Mark Trusheim, MS, BS, strategic director at the NEW Drug Development ParadIGmS program and visiting scientist at Massachusetts Institute of Technology, explains factors involved when considering whether a therapy would be suitable for performance-based contracting.

With more than 3000 gene therapies in development, payers will have to grapple with the challenges of paying for these innovative but expensive therapies.