Payers

A decision-analytic model could save more than $7 million in overall ineffective health care costs per 1000 patients by predicting which patients with rheumatoid arthritis (RA) will have an inadequate response to anti–tumor necrosis factor therapies.

Members of Congress introduce a bill to force Medicare to cover a drug they say will protect CKD patients during the COVID-19 pandemic.

Telehealth claim lines increased 4132% nationally from June 2019 to June 2020, rising from 0.16% of medical claim lines in June 2019 to 6.85% in June 2020, according to new data from FAIR Health’s Monthly Telehealth Regional Tracker.

Data presented during the European Society for Cardiology 2020 Congress were a follow-up to the presentation of VERTIS CV at the American Diabetes Association Scientific Sessions in June.

Despite progress from disease-modifying antirheumatic drugs, there is still a far greater long-term risk of undergoing total knee and hip arthroplasties in patients with rheumatoid arthritis.

A Dutch study shows how genetic testing can help couples avoid passing devastating kidney diseases to their children, but it raises issues of disparities.

The challenges of complying with payer mandates in biosimilars were discussed in a webinar sponsored by The American Journal of Managed Care® and The Center for Biosimilars®.

When a crisis hits and members become isolated, how can a health plan continue to play an active role in maintaining their health?

Proposed CMS rules would make it easier for state Medicaid programs to smooth the way for value-based contracts for high-cost gene therapies.

Given the constraints prevalent post-COVID-19, Dr Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design, stresses that it is now more important than ever for the health care industry to prioritize payment reform, value-based benefit design, and novel policy initiatives.

Despite concerns, legislation to cap out-of-pocket payments for specialty drugs has not been shown to shift costs to health plans, thereby increasing insurance premiums, according to a study published in New England Journal of Medicine.

Hinge Health announced the expansion of its clinical and technical musculoskeletal (MSK) capabilities to cover the full continuum of MSK care. The move will provide the most complete back and joint health solution to employers and health plans.

The coronavirus disease 2019 (COVID-19) vaccines that are leading the pack are utilizing a new vaccine technology that has never been approved for human use by the FDA. As a result, there are a lot of unknowns.

Patients with myeloproliferative neoplasms (MPNs) have high disease burden, and management of their disease can vary widely to include watchful waiting, phlebotomy, or drug therapy.

The race for a coronavirus disease 2019 (COVID-19) vaccine is one of the most urgent public health challenges, with multiple vaccine candidates entering phase 3 trials and case counts around the world steadily climbing. MJH Life Sciences™ will host a free webinar with the top minds in infectious disease, virology, and vaccinology to discuss the latest trial information on vaccines.

The researchers noted that these results can help inform therapeutic decision making and identify opportunities to address barriers to disease-modifying drug (DMD) adherence, which not only improves clinical outcomes but also reaps benefits when it comes to health care costs.

The study measures satisfaction among members of 149 health plans in 21 regions of the United States.

Researchers called for new guidance to address the underreporting of patient engagement in rare disease clinical trials after finding a dismal amount of patient-reported outcome measures listed in orphan drug labeling claims.

Patients with HIV who have been heavily treated but are failing their current regimen have few treatment options and are at risk of progressing to AIDS and death.

A recent article in the Journal of Head and Face Pain outlines strategies for migraine treatment without face-to-face visits, and describes ways health insurance companies can remove barriers to migraine care during the coronavirus disease 2019 (COVID-19) pandemic.

Technology has made it easier to deliver health care in the home in recent years, but the financing models have not caught up just yet.

Based on the safety and efficacy outcomes from the PREVENT phase 3 study, the FDA has approved secukinumab (Cosentyx) from Novartis for the treatment of active nonradiographic axial spondyloarthritis.

Leaders from several different accountable care organizations (ACOs) describe their experience of creating programs to care for Medicare beneficiaries using the skilled nursing facility (SNF) waiver process.

Compared with use of originator products, use of biosimilars in the United States is apparently still not a priority of commercial health plans, according to the results of a recent JAMA study.