Policy

PIE, or a preapproval information exchange, is aimed at streamlining payer and health plan involvement so that it happens at the same time a drug developer submits an application to the FDA, instead of after a drug is approved, with the intent of speeding patient access to therapies.

Neglecting public health in state budgets for more than 10 years created an environment that was ill-suited to deal with the challenges of COVID-19 as well as other issues. On this episode of Managed Care Cast, we speak with one of the authors of a recent paper that examined state funding trends from 2008 to 2018 and discuss what could be done in the future to avoid past mistakes.

Low-density lipoprotein cholesterol (LDL-C)–lowering therapies have yielded significant value to society through reduced costs for both fatal and nonfatal cardiovascular disease events. The vast majority of this value has accrued to patients.

On day 2 of this year’s Community Oncology Conference, a panel of government and health policy experts gathered to discuss the hot-button issue of political influence on cancer policy and the damage community oncology has suffered this past year.

Officials urge the Biden administration to track COVID-19 deaths among health care workers; the B.1.1.7 variant is now the dominant strain in the United States; pandemic results in steep declines in STD testing.

Anemia, which occurs in over 50% of patients with end-stage kidney disease, should not be considered an obstacle to home dialysis, according to a new report.

Phase 3 data show the Pfizer/BioNTech vaccine is effective at preventing COVID-19 6 months after the second dose; the USDA will not move forward with a plan to cut food stamps; data reveal spike in drug overdose deaths during pandemic.

To mark the beginning of National Minority Health Month, The American Journal of Managed Care® (AJMC®) takes a look at racial inequities in the COVID-19 vaccine rollout and speaks with one expert who fears reality is worse than data indicate.

Early on in the pandemic, Cotiviti developed a COVID-19 tracker map that accurately predicts where in the United States new COVID-19 outbreaks would occur. Nicole Neumarker, of Cotiviti, provides insight into what impact this technology could have in the future.

Accelerated approval drugs account for less than 1% of Medicaid spending, but states seek CMS approval to avoid coverage of these drugs and cut costs.

Anita Makkenchery, MD, MPH, and Brandy Farrar, PhD, discuss the potential for community health workers to become a regular part of the health care system in a post-COVID-19 world.

Although the FDA has approved 599 orphan drugs since 1983, patent laws and other exclusivities keep most from any competition.

The bipartisan bill spells out 5 step therapy exemptions for patients by amending the Employee Retirement Income Security Act of 1974.

As the first quarter of 2021 ends, patients choosing to keep using secukinumab may be offered an inducement to switch to another biologic, ixekizumab.

President Biden outlines new vaccine goal; the United States will stop distributing Eli Lilly's bamlanivimab; rates of human papillomavirus (HPV) decrease among females.

The announcement allowing the administration of COVID-19 vaccines in dialysis centers is part of a larger $10 billion investment, largely funded by the American Rescue Plan, to expand access.

Survey responses of 320 US hospitals highlight the dire consequences of the COVID-19 pandemic on facilities and point to a future of ongoing financial and staffing challenges.

How can health care systems talk about the issue of COVID-19 vaccine hesitancy with their patients? On this episode of Managed Care Cast, Pat Salber, MD, MBA, of The Doctor Weighs In, interviews the developer of interactive, people-centered, multimedia, educational programs for Wolters Kluwer Health.

A survey released this month of US patients with blood cancers shows a somewhat surprising level of hesitancy about receiving a COVID-19 vaccine, but because patients with cancer were not included in clinical trials, the situation for this population is somewhat nuanced.

The authors describe federal and state provider network adequacy standards and discuss how regulators should adapt these standards and accompanying monitoring processes in response to coronavirus disease 2019 (COVID-19).

Xavier Becerra, California's attorney general, will become the next secretary of HHS after the Senate voted 50-49, split by party lines.

The study examined the cost to Medicare when patients with end-stage renal disease switched from their employer-based health insurance to Medicare between 2007 and 2017 before the end of the 30-month coordination period.

This article describes a recently finalized CMS rule addressing the permissibility of co-pay accumulator adjustment programs (CAAPs) when no generic is available.

On this episode of Managed Care Cast, we speak with the chief medical officer for Virginia’s Medicaid program about 4 ways payers can make sure that those with opioid use disorder get the treatment they need; the strategies are outlined in the March issue of The American Journal of Managed Care.

Between 1999 and 2018, Black adults living in rural regions of the United States experienced high mortality rates due to diabetes, high blood pressure, heart disease, and stroke compared with White adults, according to new research published in the Journal of the American College of Cardiology.

Anita Makkenchery, MD, MPH, and Brandy Farrar, PhD, discuss how community health workers can address COVID-19 vaccine hesitancy.

A panel of policy experts, including employees of the previous 2 administrations and a former lobbyist for health plans, discusses achievements of value-based insurance design and how to take the concept to the next level.

President Biden orders states to broaden vaccine eligibility by May 1; new data from Novavax, Pfizer point to high vaccine efficacy; Supreme Court will not hear arguments on Medicaid work requirements.

This article documents a 100% increase in privately insured outpatient knee replacement surgeries following Medicare’s decision to remove knee replacements from its Inpatient Only list.

During a session presented at the America’s Health Insurance Plans (AHIP) National Health Policy Conference, Michael Chernew, PhD, the director of Healthcare Markets and Regulation Lab at Harvard Medical School, and Mark McClellan, MD, PhD, founding director at Duke Margolis Center for Health Policy, discussed the potential for Medicare innovation and reforms in 2021 and beyond.