Payers

Payers must continue to assess their prior authorization practices to uphold the goals of clinical quality, safety, and utilization management.

A comparative analysis investigating time from a drug's approval to insurance reimbursement found that the speed of this process in the US falls behind some European countries.

The disease-modifying treatment landscape has expanded in recent years, but access to the latest approved Duchenne muscular dystrophy (DMD) treatments can be a challenge for patients and providers, Aravindhan Veerapandiyan, MD, a pediatric neuromuscular specialist at Arkansas Children’s Hospital, said.

Aetna has become the first major US insurer to expand access to fertility services by covering intrauterine insemination as a medical benefit for all eligible plans, marking a significant move toward greater equity in family-building options for people of all backgrounds.

Celltrion's adalimumab-aaty biosimilar is now accessible for all Costco members, while Amgen sues Samsung Bioepis over the latter’s denosumab biosimilar candidate, and GlycoNex progresses its denosumab biosimilar SPD8 to phase 3 trials.

In this review, authors explain the supply chain issues of getting a life-saving treatment "vein to vein."

A review of the upcoming schedule of the Institute for Value-Based Medicine.

This article first appeared on The Center for Biosimilars®.

The FDA has approved axatilimab-csfr (Niktimvo) for treating adults and children with chronic graft-versus-host disease who have progressed on at least 2 prior treatments.

The immunotherapy combination was initially more costly but resulted in a lower cost of care over a 2-year period, investigators found.

Aravindhan Veerapandiyan, MD, of the Division of Pediatric Neurology at the University of Arkansas for Medical Sciences, discussed the Duchenne muscular dystrophy (DMD) therapy landscape and barriers to treatment access.

Those in minority groups face barriers even after they’ve made the hard decision to seek mental health care. The Department of Labor aims to address systemic issues on a personal level.

The Greater Philadelphia Business Coalition on Health webinar series provided an in-depth framework for the advantages of including cell and gene therapy coverage in employer health plans, as well as the challenges brought by manufacturing complexities and the need to address accessibility to treatment.

The 2025 Physician Fee Schedule includes a conversion factor reduction, expanded behavioral health services, extended telehealth waivers, new Quality Payment Program pathways, and measures to address suspect billing, alongside a Biden administration initiative introducing federal maternal health standards for hospitals.

After evaluating the association between the expanded Medicare Advantage supplemental benefits and plan composition, authors determined that adoption was not associated with large demographic shifts in enrollment.

Beneficiaries who switched from traditional Medicare to a Medicare Advantage plan experienced no additional protection from medical costs compared with those who stayed in a traditional Medicare plan.

The FDA today approved efgartigimod alfa and hyaluronidase-qvfc for the treatment of adult patients with chronic inflammatory demyelinating polyneuropathy (CIDP).

Ali Khawar, principal deputy assistant secretary with the Employee Benefits Security Administration (EBSA), US Department of Labor, explains how the Mental Health Parity and Addiction Equity Act (MHPAEA) aims to address the mental health crisis in the US.

The Bundled Payments for Care Improvement program was associated with improved quality of skilled nursing facilities in hospital referral networks for patients undergoing surgery for joint replacement.

This study quantified the trends over time in utilization of, spending on, and access to CT fractional flow reserve, the first artificial intelligence (AI)–enabled clinical software reimbursed by Medicare.

A new program from Optum Rx would offer greater predictability by using a guarantee-based pricing model.

The FDA approved the first 2 biosimilars referencing aflibercept (Eylea). However, patent litigation has left it unclear when the biosimilars will come to market.

Pembrolizumab has existing indications in endometrial cancer.