Payers

Medicare Advantage plans have a clear opportunity to improve quality by delivering more comprehensive, timely medication reconciliation services to recently discharged members.

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.

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.

Generally, life sciences companies are aligned around the benefit of using value-based insurance design (VBID) to address health care costs and ensure that medications get to the patients who need them.

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).

Pharmacists from the Cleveland Clinic discuss the impact of payer dispensing requirements, known as white bagging and brown bagging, on oncology practices and on patients.

Minimal residual disease (MRD) is being used more frequently in clinical trials and to identify the best treatment course for patients, but unknowns remain about the optimal use of MRD testing.

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.

A panel of experts provided consumer insights into value-based insurance design (VBID) and how the COVID-19 pandemic may have changed consumer behaviors in a way that VBID may be able to address as the country emerges from the pandemic.

A desire to remove barriers to high-value care and provide services that would improve health and quality of life drove early adopters of value-based insurance design (VBID).

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.

Whole-genome sequencing (WGS) is at least as accurate as conventional tests when it comes to genomic profiling in patients with acute myeloid leukemia and myelodysplastic syndromes.

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.

The $1.9 trillion spending package aimed at providing COVID-19 relief for those with low and middle incomes also represents the biggest investment in the exchange marketplaces created by the Affordable Care Act (ACA) since the landmark law was passed 11 years ago.

Investigators sought to better understand increasing price trends, including those seen among disease-modifying drugs to treat multiple sclerosis (MS) and other neurological diseases.

A review of evidence finds that oxygen therapy may be beneficial for all patients with pulmonary arterial hypertension, not just those who develop severe hypoxemia.

Direct inpatient and outpatient costs are significantly higher for patients with untreated spinal muscular atrophy (SMA) compared with matched controls.

The specialization program will teach fundamentals and offer real-world examples of value-based care through an online program.

Medicare Advantage enrollees are more likely to be treated with metformin and sulfonylureas and less likely to receive costly newer medications than those in traditional Medicare.

Kavita Patel, MD, MS, FACP, a fellow at the Brookings Institution Center for Health Policy, touched on key topics in health care at the ACCC 47th Annual Meeting and Cancer Center Business Summit.

Jeffrey Hogan, Northeast regional manager of the Rogers Benefit Group and member of the Board of Directors for the Connecticut Business Group on Health, discussed how his organization helped providers navigate some of the challenges posed by the pandemic.

Use of a specialty pharmacy to take over the management of prior authorization (PA) requests for a dermatology practice significantly reduced the time to a decision and also decreased the time it took to fill the medication.