Medicare Part D low-income subsidies alone are insufficient to improve the uptake and equitable use of high-cost, orally administered antimyeloma therapy.
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Tacking Upwind: Reducing Spending Among High-risk Commercially Insured Patients
Although commercial accountable care organization populations are healthy on average, some individuals might benefit from programs for high-risk patients to mitigate high levels of health care utilization.
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Study Reveals Factors That Dissuade Commercial Plans From Covering Biosimilars
April 22nd 2023A study assessing factors that may determine a commercial health plan’s likelihood of covering a biosimilar found that biosimilars that are cancer therapies, used to treat children, indicated for highly prevalent conditions, or only competing against the originator were more likely to have coverage restrictions.
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Prior Authorization Requirements for Calcitonin Gene-Related Peptide Antagonists
April 20th 2023This quantitative and qualitative analysis highlights differences in prior authorization requirements for migraine drugs from nearly 50 managed care organizations and summarizes broad types of criteria used.
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Population Turnover and Leakage in Commercial ACOs
Payment models that align financial incentives of payers, providers, and patients can mitigate spending growth in thoughtful ways, but the details of the models matter.
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Building Equity Into Value Assessments Requires Changing the Rules of the Game
April 7th 2023Equity has to be made front and center in conversations about value assessment, otherwise all stakeholders will continue waiting for someone else to make the first move, said one panelist at the Value-Based Insurance Design Summit.
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Part D Beneficiaries’ Incentives and Responses Under Preferred Pharmacy Networks
April 4th 2023Under preferred pharmacy networks, unsubsidized Part D beneficiaries faced substantial incentives and moderately switched toward preferred pharmacies, whereas subsidized beneficiaries were insulated and demonstrated little switching.
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Development of a Medicare Plan Dashboard to Promote Health Equity
Health plans use data to decide on quality improvement initiatives. Having a dashboard that characterizes how equitably plans are serving their enrollees would promote health equity.
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Panel Addresses How Payers, Providers Can Optimally Use Real-World Evidence to Advance Cancer Care
February 23rd 2023Utilizing real-world evidence that applies to the specific care needs of certain patient populations can promote timely decision-making among payers and providers on the use of effective cancer therapies available on the market, said panelists at the 2022 Patient-Centered Oncology Care® (PCOC) meeting.
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The government is allowing Medicare Advantage (MA) plans to delay returning hundreds of millions of dollars or more in government overpayments; a proposed new extension of the Affordable Care Act (ACA) might make birth control coverage more accessible for certain private insurance plans; a study found that students lost around 33% of their school year because of the pandemic’s educational barriers and are struggling to regain that lost time.
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Adults With Diabetes in High-Deductible Health Plans More Likely to Have Severe Hyperglycemia
January 26th 2023Adults with diabetes who were forced to switch from an employer-sponsored health plan to a high-deductible health plan (HDHP) were 25% more likely to require an emergency department (ED) or hospital visit for hyperglycemia, but not for hypoglycemia, than those who did not switch plans.
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Contributor: Promoting Health Equity Through Primary Care
January 23rd 2023Jodi Fenner, senior director at Elevance Health, speaks on the key themes she presented during her session at the 2023 Health Equity Summit in San Diego, California, titled, "Promoting Health Equity through Primary Care."
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HDHPs Deter Women From Additional Testing After Abnormal Mammogram, Study Says
November 29th 2022The groups who told researchers they would be more likely to skip additional testing had lower levels of income or education and were more likely to be on Medicaid or be uninsured, among other factors.
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The Department of Veterans Affairs (VA) will give cancer claims priority when a new law takes effect in January 2023; Pfizer is looking to use its COVID-19 profits to grow other blockbusters; the probable loss of Medicaid coverage for millions next year is setting off debate.
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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.
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