Health Care Cost

Due to anticompetitive practices, the United States lags Germany and Switzerland in the number of biosimilars on the market, while also having substantially higher prices for both biosimilars and reference products.

The increasing complexity and costs of oncology care and resulting patient financial toxicity is driving more health systems to adopt oncology stewardship principles in their pharmacy practices, according to a session at the American Society of Health-System Pharmacists (ASHP) 2022 Midyear Clinical Meeting & Exposition.

Ferring’s Rebyota, a novel first-in-class microbiota-based live biotherapeutic, has been approved by the FDA for the prevention of recurrence of Clostridioides difficile infection (CDI) in individuals 18 years and older, following antibiotic treatment for recurrent CDI.

Melissa O'Connor, PhD, MBA, RN, FGSA, FAAN, endowed professor in community and home health nursing, M. Louise Fitzpatrick School of Nursing, Villanova University, and director, Gerontology Interest Group, addressed barriers related to access, cost, and knowledge impeding technology use in home health.

Tam C. Phan, PharmD, AAHIVP, assistant professor of clinical pharmacy, USC School of Pharmacy, talks about how HIV pre-exposure prophylaxis (PrEP) therapies in the pipeline address disparities in patient access and adherence.

Patients with Medicare Advantage (MA) were 1.5 times more likely to die within a month of surgical removal of their stomach or liver, and twice as likely to die within a month of oncologic surgery of the pancreas, compared with patients with traditional Medicare.

There is a major role for telehealth in oncology care, not only for its convenience but also for giving clinicians the ability to scale nononcologic visits, explained Emeline Aviki, MD, MBA, FACOG, assistant attending gynecologic cancer surgeon at Memorial Sloan Kettering Cancer Center (MSKCC) in New York City and lead of the MSKCC Affordability Working Group.

Michael Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions (National Alliance), discussed findings of the survey that was presented at the National Alliance 2022 Annual Forum and what concerns employers and business coalitions had regarding the current state of health care cost, delivery, and coverage.

Stephen M. Schleicher, MD, MBA, chief medical officer at Tennessee Oncology, addresses the “huge problem” of financial toxicity among patients with cancer, which can be attributed in part to both the high price of targeted treatments and even from ordering only necessary testing.

An analysis of Medicaid coverage found that Mississippi was the only state not to provide coverage for human papillomavirus (HPV) vaccination in adults aged 27 to 45 years.

Findings suggest that Basaglar was not less expensive for patients than Lantus. Empirical evaluation of biosimilar costs prior to automatic substitution is necessary.

The analysis emphasizes the association between vaso-occlusive crisis frequency and health care costs, which are inflated largely due to inpatient visits.

Gene therapy is a novel approach to hemophilia A treatment that carries a substantial cost up front but may lead to cost savings compared with current prophylaxis agents in the long run.

Daniel E. Weiner, MD, MS, board certified nephrologist and lead navigator at Tufts Clinical and Translational Science Institute, spoke on the limitations and future potential of value-based payment systems for chronic kidney disease (CKD), including the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model and the Kidney Care Choices (KCC) Models.

It has been 3 years since new kidney care payment models were announced by HHS, and at a session at Kidney Week 2022, the associate division director of nephrology at the University of Alabama at Birmingham described his organization’s participation in Kidney Care First, one of the value-based care models announced in 2019.

A poster presented at the Academy of Managed Care Pharmacy Nexus 2022 showed that patients with recurrent Clostridioides difficile infection (rCDI), who had Medicare Advantage Part D coverage or were enrolled in a commercial health plan were associated with significantly greater health care resource utilization, including emergency department and inpatient visits, compared with those without rCDI.

A poster presented at Academy of Managed Care Pharmacy Nexus 2022 shows that patients with intermediate Parkinson disease place a significant resource burden on the US health care system in regard to treatment, emergency department visits, and admissions to rehabilitation centers.

Jim H. Rhodes, deputy county administrator, Camden County, New Jersey, spoke on how his organization’s membership with the Greater Philadelphia Business Coalition on Health (GPBCH) has aided their value-based initiatives in improving health equity in the region.

Emergency department (ED) readmission was more common than dermatology follow-up among patients with hidradenitis suppurativa (HS) within 30 and 180 days of initially presenting to the ED, with patients with Medicaid coverage and those who had an opioid prescribed were more likely to return.

Brian Corvino, MBA, managing director, Life Sciences and Health Care Practice, Deloitte Consulting, LLP, offered an overview of how the surge of innovation in oncology—and resulting drug approvals—dominate the biopharmaceutical sector. He spoke at the Community Oncology Alliance's Payer Exchange Summit.

Neil Goldfarb, president and CEO of Greater Philadelphia Business Coalition on Health (GPBCH), spoke on the biggest challenges facing GPBCH in advancing health care value, how national organizations are helping drive innovation, and the future role of business coalitions in the health care system.

The limited data on heart failure (HF)-related mortality among young adults, those aged 15 to 44 years, prompted this analysis of data from 1999 to 2019 that considered HF as a contributing or underlying cause of death.

Panelists who have reviewed the Enhancing Oncology Model (EOM) say it puts additional requirements on practices with reduced monthly payments, and its risk modeling could put a small practice out of business.

Black and Latino Americans saw surges in health care insurance enrollment through the Affordable Care Act (ACA) between 2020 and 2022; Medicaid enrollment and spending is expected to slow in 2023; the Biden administration is preparing a national hepatitis C treatment plan.

Despite known racial disparities in access to advanced heart failure (HF) treatments, the reasons for this continue to require further exploration. In this new study, investigators searched for associations between ventricular assist device use and heart transplant and race (Black or White).

CDC advisory group votes to add COVID-19 vaccines to the pediatric immunization schedule; a new report says workplaces can be hazardous to the mental and physical health of Americans; drug makers are lobbying to ease the impact of the Inflation Reduction Act.

The goal of this new study was to gain more information on the disease burden, including costs, of patients living with chronic rhinosinusitis with nasal polyps (CRSwNP).

Black and Hispanic patients living with chronic inflammatory skin disease (CISD) have more barriers to care compared with White patients with CISD, according to a recent study.

Biosimilars have had such an impact on driving down costs, that in some instances the reference product might be the lowest cost option, explained Paul Forsberg, PharmD, director of pharmacy, Minnesota Oncology.

Panelists at an Academy of Managed Care Pharmacy (AMCP) Nexus 2022 session discussed enhanced utilization management strategies to manage the rising cost of specialty drugs, while providing members with support for rare, complex conditions.