|Videos|June 19, 2013
Episode 6 - Recommended Guidelines and Payer Challenges
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Episodes in this series
Treatment guidelines are now recognizing and suggesting immunotherapy for the treatment of several types of cancer.
However, Jeffrey Weber, MD, PhD, explains that the unspoken issue in regard to immunotherapies is that most are investigational. With respect to a payer covering treatment, in different states throughout the country, some will cover research-related costs and some will not.
As the panelists discuss how coverage inconsistencies, or the lack of coverage altogether, challenges providers to offer treatment as suggested by important NCCN guidelines, Daniel J. George, MD, concludes that there is no real way to develop a standard policy without reviewing each case individually.
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In states that covered obesity-labeled GLP-1 RAs, total GLP-1 RA use rose less than obesity-labeled use alone, suggesting possible substitution.
HR 1 brings Medicaid work requirements and narrower immigrant eligibility by January 2027, and CBO projects 10 million more uninsured by 2034.
CMS ends ACA subsidies for 189,000 enrollees with duplicate Medicare, Medicaid, or CHIP coverage or listed as deceased, with a 30-day dispute window.
MedHaul’s platform streamlines nonemergency medical transportation, boosting on-time oncology visits, reducing costs, and helping patients reach critical care across underserved regions.
Medicare drug price negotiations lowered out-of-pocket costs for some beneficiaries, but those reaching the annual Part D cap saw no direct savings.
The editor in chief of Evidence-Based Oncology, who was recently named medical director of Precision Medicine for The US Oncology Network, discussed milestones met and those still to be achieved.
Alice Hall-Partyka, JD, a partner at Crowell & Moring explains the lawsuits challenging CMS' Medicaid rule on pediatric gender care and its legal weak points.
Siva Mohan, MD, explains how drug costs drive silent nonadherence, PA burden, and biosimilar hesitancy, and what payers can do about it.
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