Payers

A comparison of type 2 biologics indicated for the treatment of chronic rhinosinusitis with nasal polyps identified dupilumab as the most effective drug in decreasing nasal polyp score and nasal congestion severity, whereas benralizumab was least effective.

Robert Sidbury, MD, MPH, chief, Division of Dermatology, Seattle Children's Hospital, spoke on considerations for dermatologists in seeking payer coverage of novel, expensive therapies for atopic dermatitis.

The annual spring meeting of AMCP 2022 will include keynote sessions on health care and marketplace trends and the specialty pharmaceutical pipeline, with a featured preconference session on bias in health care.

Patients switched from the originator product maintained their clinical outcomes and remissions status while biologic-naïve patients recorded positive responses and remission outcomes after initiating infliximab-dyyb.

Coverage of COVID-19 tests and treatment bills halted for uninsured; Moderna low-dose vaccine in children under 6 years of age shows promise in early clinical trial findings; Pfizer recalls blood pressure medications due to potential carcinogen.

The Global and Professional Direct Contracting model is going to be replaced with a new accountable care organization (ACO) model, which addresses some of the pushback there had been on the direct contracting model, said Michael Chernew, PhD.

A provisional clinical opinion from the American Society of Clinical Oncology (ASCO) recommends that patients with advanced cancer with specific genomic alterations undergo genomic sequencing.

Jim Schwartz, RPh, corporate pharmacy manager, Texas Oncology, discussed pharmacy challenges regarding equitable care and distribution of specialty drugs in the community oncology setting.

Incident end-stage kidney disease cases more than doubled among Asian individuals, and prevalent cases more than tripled for Asian, Native Hawaiian or other Pacific Islander, and Hispanic individuals.

While filgrastim biosimilars had substantial uptake, there was low uptake of infliximab biosimilars. In addition, there was a lack of price competition.

Michael Diaz, MD, president and managing physician, Florida Cancer Specialists & Research Institute, speaks on takeaways from his discussions on site of care and pharmacy benefit managers (PBMs) at the 2022 Community Oncology Conference.

The phase 3 trial of valoctocogene roxaparvovec for severe hemophilia A showed it reduced bleeding events as well as the use of factor VIII concentrates.

The FDA based its approval on OlympiA trial data, which show the PARP inhibitor has the ability to reduce risks of invasive breast cancer recurrence, second cancers, and death, and to improve overall survival.

A study from Japan identifies markers for a presurgical staging system in intrahepatic cholangiocarcinoma, with results on par with an existing postsurgical staging system.

After years, the biosimilars horizon may be here with valuable opportunities to improve patient outcomes and reduce costs, said Eric Palmer, president and CEO of Evernorth.

On this episode of Managed Care Cast, we speak with Tim Gronniger, the CEO of Caravan Health, about what to look for as accountable care organizations (ACOs) and policy makers try to encourage more providers to join value-based care arrangements.

This article explores the impact of payment models (fee for service vs salary based) on practice patterns, including wait times and care for patients with chronic diseases.

Survey results demonstrate an opportunity to incorporate good practices for high-deductible health plans that can help enrollees maximize value and better navigate their benefits and treatment options.

On this episode of Managed Care Cast, Marcelina Jasmine Silva, DO, discusses her recent work on prolonged cessation of chronic opioid analgesic therapy among patients with chronic noncancer pain.

An editorial in response to the editor-in-chief’s December 2021 letter describes how a payer continues to push the limits of innovation through shared learnings and collaboration.

The economic burden of rare diseases based on direct, indirect, and mortality-related costs is 10 times greater than the burden for mass market diseases, such as diabetes and cardiovascular disease, and this burden increases when no treatment is available.

A new lawsuit aims to block a $13 billion health insurance acquisition; the CDC is expected to release updated mask guidelines; the European Medicines Agency supports boosters among teenagers for COVID-19.

During an AHIP webinar, Mark Hamelburg, senior vice president of federal programs at AHIP, explained the shifts coming to Medicare and Medicaid when the public health emergency finally ends.

The redesigned accountable care organization (ACO) model is called the Realizing Equity, Access, and Community Health model and is scheduled to begin in 2023.

Jacob Sands, MD, who leads the small cell lung cancer research program at Dana-Farber Cancer Institute, speaks with The American Journal of Managed Care (AJMC®) about the need for more patients who meet the criteria for lung screening to catch cancer before it reaches an advanced stage.

AHIP released a report looking at the price markups for 10 drugs that can be delivered more affordably through specialty pharmacies, including 3 drugs with multiple biosimilars available.

The president’s aim is a 50% reduction in age-adjusted cancer deaths by 2047. This goal seems audacious, but it is likely achievable.

AHIP has released a new set of privacy principles that reaffirm the health insurance provider industry’s commitment to developing privacy, confidentiality, and cybersecurity practices to protect personal health information.

By making diligent compliance efforts a priority in the years ahead, health plans can shore up existing processes to achieve financial success and ensure risk adjustment as regulatory bodies take aim at organizational missteps.