Payers

In an interview, Debra Patt, MD, PhD, MBA, FASCO, discusses the priorities of the Community Oncology Alliance as she starts her term as president.

Two new measures tied to outcomes drawn from data in the CLEAR phase 3 trial will be presented during the ASCO Genitourinary Cancers Symposium later this week in San Francisco, California.

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

Relying on veteran survey responses and novel actuarial data, the authors examine the relationship between benefit value and reliance on the Veterans Health Administration.

World Cancer Day also marks the start of the ‘United by Unique’ campaign, which seeks to highlight how each person’s journey with cancer is unique, even though the patients, caregivers, and health care teams who are touched by cancer are united by shared goals.

Amid the uproar over the firing of 18 inspectors general, a report offering a coda to the aducanumab approval episode has been overlooked. It shows the need for reforms of the FDA's accelerated approval process.

The high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.

Semaglutide (Ozempic) is 1 of 15 medications that will be included in yearly price negotiations between Medicare and manufacturers.

Altruism values for treatments of rare, severe pediatric diseases have not been estimated. This study found the altruism value for a hypothetical new Duchenne muscular dystrophy treatment to be $80 per year.

If the subcutaneous delivery method gains approval, an advantage daratumumab holds over isatuximab would be removed.

The authors used medical loss ratio forms to assess trends in premiums, medical claims, administrative costs, quality improvement, and margins in the large group insurer market.

Data from a systematic review of 30 real-world studies show comparable discontinuation rates of ocrelizumab to those in pivotal clinical trials among patients with different types of multiple sclerosis (MS).

The most-read obesity articles of 2024 mostly focused on insurance coverage of weight loss medications and costs.

Coverage from the IVBM Regional event in Denver, Colorado.

Payers and employers have tightened access to the glucagon-like peptide 1 receptor agonist class once these therapies became more commonly prescribed for obesity.

Lindsay Bealor Greenleaf, JD, MBA, of ADVI Health, weighs in on what to expect in key health care policy areas in the wake of the election.

Authors found the pharmacy costs for momelotinib were $11,095 higher per month, too much to offset higher transfusion costs for ruxolitinib.

Being married and having insurance can offer emotional support and financial stability to lead to early diagnosis and effective treatment, the authors found.

New legislation would clarify rules around value-based contracts in Medicaid, and a new model is expanding access to gene therapies, explained Adam Colborn, JD, of AMCP.

As health care costs escalate, a new survey reveals that 74% of employers are grappling with the impact on employee wages and benefits, with many anticipating further cost-shifting to their workforce.

Stuart Staggs, vice president of transformation and shared services at McKesson, explained that oncology practices in the Enhancing Oncology Model (EOM) have a tough job driving down costs when drug costs make up a larger portion of the total cost of care.

Medicaid, Medicare, and private insurance programs all showed significant variability in expenditures based on social and nonclinical factors.

The Wellth smartphone app significantly increased medication adherence and lowered unnecessary health care utilization and costs over 9 months among Medicaid beneficiaries who were self-managing chronic conditions.

There is a role for both payers and providers to make small changes that would increase the use of biomarker testing to ensure patients are receiving the appropriate treatment, said Susan Wescott, RPh, MBA, senior director of managed care pharmacy, Mayo Clinic.

Co-pay accumulators and maximizers are 2 programs that insurers have started implementing to help them redirect financial assistance from the patient, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.

A review of positions and track records of Vice President Kamala Harris and former President Donald Trump on reproductive health, the future of the Affordable Care Act, prescription drug costs, health care consolidation, and a proposed Medicare home health benefit.

The prevalence rates of metabolic dysfunction–associated steatohepatitis (MASH) and metabolic dysfunction–associated steatotic liver disease (MASLD) are likely underestimated using claims data alone.