The biggest battle in healthcare these days-besides the ongoing fight over Obamacare-is over the price of expensive life-saving medications.
The biggest battle in healthcare these days—besides the ongoing fight over Obamacare—is over the price of expensive life-saving medications.
The fight centers on how drug benefits are designed in health plans, particularly the use of benefit tiers. Health plans usually put lower-cost and preferred drugs at lower tiers that come with smaller out-of-pocket costs. But in the last few years, tiers have become more complex.
The tiers have grown from 2 to 3, 4 and 5. Plans now often distinguish between preferred generics and non-preferred generics, as well as preferred and non-preferred brand name drugs. Specialty medications, which according to one estimate cost 50 times more than a traditional brand-name drug, are found in the highest tiers. Patients usually pay a percentage of the cost of these expensive drugs, or co-insurance, in contrast to the set co-pays charged for medicines in lower tiers.
Read more at The Washington Post's Wonkblog: http://wapo.st/1x3T0pD
Standard Criteria for Loss of Ambulation Needed in DMD
April 19th 2024A recent study suggests the differences between ambulation definitions for patients with Duchenne muscular dystrophy (DMD) can impact the identification of ambulant vs nonambulant individuals, and standard criteria across settings are needed.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
An Overview of Health Care and Pharmaceutical Trends, 2023-2024
April 19th 2024Douglas M. Long, BA, MBA, was featured as the keynote speaker on the closing day of The Academy of Managed Care Pharmacy 2024 annual meeting, with a session dedicated to surveying the health care and pharmaceutical trends of the last year.
Read More
Drs Raymond Thertulien, Joseph Mikhael on Racial Disparities in Multiple Myeloma Care Access
December 28th 2023In the wake of the 2023 American Society of Hematology Annual Meeting and Exposition, Raymond Thertulien, MD, PhD, of Novant Health, and Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation, discussed health equity research highlights from the meeting and drivers of racial disparities in multiple myeloma outcomes.
Listen
Real-World Study Reveals Key Insights Into DLBCL Treatment Patterns, Outcomes
April 18th 2024A recent study offers valuable insights into the characteristics, treatment patterns, and outcomes of diffuse large B-cell lymphoma (DLBCL) in patients across different lines of therapy, providing a look into the landscape of DLBCL management.
Read More