Policy

The Inflation Reduction Act (IRA) contains provisions allowing Medicare to negotiate net prices for prescription drugs, but it remains to be seen whether this will translate into savings for beneficiaries, explained A. Mark Fendrick, MD, co–editor in chief of The American Journal of Managed Care® and director of the V-BID Center at the University of Michigan.

The FDA authorizes the COVID booster shots for children as young as 5; babies born during the pandemic may experience delayed communication skills compared with babies born prior; regulatory burden has increased for 89% of medical practices.

On this episode of Managed Care Cast, we speak with Matthew D. Eisenberg, PhD, lead author of a study published in the October issue of The American Journal of Managed Care® that investigated the use of high-deductible health plans and their impact on substance use disorder care and spending.

Stakeholders at the Academy of Managed Care Pharmacy (AMCP) Nexus 2022 meeting review federal legislative and regulatory updates in managed care pharmacy and the impact that upcoming midterm elections will have on these provisions.

The bill was introduced by 2 Republicans and 2 Democrats and would direct HHS to undertake a study to understand how substitution of interchangeable biologic products may be impeded.

The impact of the COVID-19 pandemic on pediatric heart transplant waiting list times was evaluated in this new study that used data from the United Network for Organ Sharing.

The annual fall meeting of AMCP Nexus 2022 will feature a keynote from one of the top physician-executives in health care, the specialty pharmaceutical pipeline, and insights for managed care stakeholders in selecting and integrating cost-effective, value-based care frameworks.

Enrollees who join Medicare Advantage undergo significant turnover in the years following enrollment.

There is wide variation in the governance over research participant pay, and with rapid advances in technology enabling trial access, industry should step up and pay patients what they are worth, says Gunnar Esiason, a patient advocate living with cystic fibrosis.

The recommendations aim to make this type of evaluation more consistent in cases when children have suspicious bruising or bleeding patterns.

The annual report notes that progress in reducing cancer mortality is uneven among populations, with minority groups not seeing the same benefits from therapeutic advances. Cancers related to obesity are also on the rise.

A deal was reached to renew 5-year FDA user fee programs; children and adolescents with COVID-19 had a 60% increased risk of developing type 1 diabetes (T1D); states cannot penalize Department of Veterans Affairs (VA) employees for facilitating abortions permitted by federal law.

Researchers used 2011-2020 data to examine age- and race-/ethnicity-related trends in hypertension diagnosis, with implications for future cardiovascular disease care.

Danielle Carnival, PhD, addressed the National Comprehensive Cancer Network Policy Summit on Friday.

On this episode of Managed Care Cast, we speak with 2 authors of an article in the September issue of The American Journal of Managed Care®, which focused on the results of their evaluation of an intensive, community-based care management program for dual-eligible Medicaid ACO high-risk patients.

Streamlining the prior authorization process can improve care accuracy and patient access to care, writes Siva Namasivayam, CEO of Cohere Health.

A recent study showed that receiving Supplemental Nutrition Assistance Program benefits was not enough to address food insecurity among families whose children were fighting acute lymphoblastic leukemia.

Newer therapies, such as ketamine or esketamine, or the broader use of bright light therapy, made an updated clinical practice guideline for treating major depressive disorder (MDD), but psilocybin and cannabis did not.

Nearly 30% of youths are affected with worsening mental health by the end of adolescence, with anxiety typically presenting in childhood and depression during the teenage years, but the problem is even more acute for Black and Latinx youth.

Russell Rotondo, MD, FACC, medical director of clinical strategy and innovation for cardiology at Cohere Health, discusses the myriad positive ways utilization management programs can have an impact on patient outcomes in cardiovascular care.

A new review article explains the role of biologics in treatment systemic lupus erythematosus (SLE) and lupus nephritis.

COVID-19–driven telehealth exposure positively shifted physician respondents’ perceptions of telehealth effectiveness, and most are likely to continue use if temporary telehealth regulatory flexibility is permanently extended.

State surprise billing protections decreased emergency department (ED) out-of-pocket payments to such an extent that ED visits actually increased.

David E. Koren, PharmD, MPH, BCPS, AAHIVP, FIDSA, infectious disease clinical pharmacist at Temple University Hospital, provides an update on current preventive efforts to address the monkeypox public health emergency in the United States and what steps are needed to protect at-risk populations.

Using systemic corticosteroids (SCS) to treat chronic rhinosinusitis with nasal polyps (CRSwNP) has been linked to adverse outcomes among patients, prompting these study investigators to compare their health care resource utilization with that of patients who have CRSwNP but don’t use SCS.

This article presents a detailed descriptive analysis of how Massachusetts and Minnesota implemented Medicaid accountable care organization (ACO) models for their managed care population.

Following a recent update to the diagnostic criteria for borderline pulmonary hypertension (PH), which is often associated with left heart failure (LHF), outcomes among patients with both conditions remain uncertain.

The authors describe a pay-for-performance initiative targeting behavioral health providers, which was introduced by a large Medicaid managed care organization across multiple states.

An editorial in response to the editor in chief’s December 2021 letter discusses alignment of specialist physicians with value-based care initiatives.

CVS announces its plan to buy Signify Health for $8 billion; government budgets and low reimbursement could limit the ability for new moms to stay on Medicaid for a year after childbirth; the long-lasting symptoms of COVID-19 could be keeping millions of people out of the workforce.