Payers

The upfront prices of potentially curative therapies are terrifying to commercial payers and government payers alike. A panel on the last day of ISPOR 2019 discussed these issues in a session called, “Is Affordability Driving a Need to Revolutionize Drug Pricing?”

Changing patients from an inhaled corticosteroid (ICS)/long-acting β agonist (LABA) inhaler and long-acting muscarinic agonist (LAMA) inhaler to a LAMA/LABA inhaler and a separate ICS inhaler did not appear to affect patient-reported chronic obstructive pulmonary disease (COPD) symptom scores.

A report from the Health Care Cost Institute examined 4 years' worth of data covering 1.8 billion claims in 112 markets.

We surveyed biopharmaceutical manufacturers and payers to understand the prevalence and characteristics of value-based payment arrangements, as well as their implementation obstacles and success factors.

HHS released 2 long-awaited rules meant to transform how health records and medical claims are delivered and communicated, with one aimed at aggregating electronic health records and claims information into an interoperable mobile format that patients could call up on their devices and another that would require that access to electronic health information come at no cost to the patient and end information blocking.

Research and regulatory gaps in the use of marijuana will only grow unless the scientific community and policy leaders fill the void, according to a commentary series in Annals of Internal Medicine on marijuana’s rising availability.

The year 2019 will finally be when the healthcare industry, particularly payers and providers, finally begins to catch up to other industries in terms of giving the consumer what they want.

A perspective on the current FDA guidance for diabetes therapies.

If the trial is successful, venglustat could be the first treatment to target the mechanism of action in autosomal dominant polycystic kidney disease (PKD), which affects 120,000 people in the United States.

Despite impending changes in Washington, DC, as the Democrats are set to take over the House of Representatives in 2019, the divided federal government could lead to a spell of predictability for some healthcare sectors as most action shifts to the state level.

Pharmacy benefit managers (PBMs) will have to disclose some information about their compensation and relationships with payers.

A coalition of diverse interest groups—payers, unions, and business groups—wrote Senate leaders Monday to express their opposition to the inclusion of “pay for” legislation regarding end-stage renal disease (ESRD) in an opioid bill passed in June by the House of Representatives.

Payers and providers are looking to keep vulnerable patients in pain from becoming addicted to painkillers, but those who live with pain on a daily basis are understandably upset at the thought of losing access to medications they say keep them functional. Here are 5 takeaways from recent coverage about this important issue.

Using the example of low back pain, a study in JAMA Open suggests insurers could help to reduce opioid overuse by expanding access to nonopioid alternatives through improved coverage and reimbursement policies.

Compared with the general population, adults who survive an opioid overdose are 24 times more likely to die during the year after the incident from a variety of mental health and medical conditions, including from substance use–associated diseases and suicide, according to a study published in JAMA Psychiatry.

Authors from Foundation Medicine explain the regulatory path that led to approval of FoundationOne CDx.

For true comprehensive community wellness to take place, barriers must end between the old silos of what is considered “healthcare” and what is considered public health, in order to improve health outcomes and curb rising costs, according to a new report from The Health Care Transformation Task Force and The Public Health Leadership Forum.

Featured experts to discuss practical experiences, challenges, and successes from within the Oncology Care Model.

Which data, policy, and information gaps exist throughout the healthcare system and need filling in order to combat opioid use disorder (OUD) through better prevention and treatment strategies? Two recent reports discuss how these gaps are worsening efforts to fight OUD.

This week's announcement comes after cardiologists have spent several years sharing accounts of their difficulty gaining access to PCSK9 inhibitors for their patients.

Problems in healthcare seem overwhelming, with at least 17 different factors cited as driving unsustainable spending, according to a presentation at the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting held April 23-26, in Boston, Massachusetts. Two executives from Precision for Value LLC spoke about “Charting the Shifting Value-Based Healthcare Landscape: Emerging Developments for 2018 and Beyond” and offered their view on what healthcare companies can do to succeed.

Genomics-based precision medicine has the potential to transform healthcare delivery. However, effective collaborations among scientists, clinicians, and payers are needed to accelerate the translation of precision medicine to clinical practice and ensure its sustainability.

Adherence may play a role in the real-world findings of the study, which was sponsored by Janssen.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included Sanofi offering a deal to payers for its cholesterol drug; a “right-to-try” bill is defeated in the House; and a forum of oncology pharmacists discusses “health insurance” versus “healthcare.”

Sanofi–Regeron's offer to cut prices if payers improve access comes on the heels of the FDA Commissioner's critique of the "Kabuki" constructs that harm the sickest patients.

Since 2000, the number of patients undergoing gender-affirming surgery who identified as self-payers decreased. From 2012-2013 to 2014, coverage by Medicare and Medicaid of gender-affirming surgeries increased 3-fold.

Driven by an aging US population and other economic and demographic factors, national health spending is projected to climb to 19.7% of the economy over the next 8 years, up from 17.9% in 2016, according to new estimates released Wednesday from CMS and published online in Health Affairs.

Empagliflozin (Jardiance) and another SGLT2 inhibitor, canagliflozin (Invokana) have been competing aggressively; both have clinical trial results showing cardiovascular benefits.

Researchers were especially concerned about barriers for patients with familial hypercholesterolemia, whose needs would seem clear cut but who nonetheless faced costly hurdles, such as genetic testing.