Payers

This study leverages newly available hospital pricing data to explore hospital-insurer contracts from a large hospital chain.

At an Institute for Value-Based Medicine® event held in Phoenix, Arizona, experts from Banner Health and Aetna discussed how health inequities and social determinants of health can affect primary care in patients with any type of insurance.

Patients enrolled in a preventive drug list (PDL) benefit saw an 8.4% reduction in acute, preventable diabetes complication days, and PDL members residing in lower-income areas saw a 10.2% decrease compared with control members.

UnitedHealthcare is incorporating real-world evidence into pathways design and policy formulation, leveraging its members' data to evaluate the impact of different regimens on health resource utilization and costs, explains Lucy Langer, MD, MSHS, national medical director of oncology and genomics at UnitedHealthcare.

Drug prices in the US increased 4.4% annually and median out-of-pocket (OOP) costs increased 9.6% annually from 2009 to 2018, but there was no direct link between these amounts for individual drugs.

In a systematic review and meta-analysis, real-time continuous glucose monitoring (CGM) demonstrated benefits in terms of time in range, hypoglycemia, and hyperglycemia among patients with type 1 diabetes (T1D).

Findings from PREVENT-HF put to rest the idea that once remodeling in the heart's structure starts following anthracyclines that nothing can be done to treat it.

Based on a comparison of prices for drugs up for Medicare price negotiations, there is a long way to go to reach the prices of 7 comparable countries.

The author, chair of the Government Affairs Committee with the American College of Rheumatology, calls for support for efforts in Congress to reform the Physician Fee Schedule.

Melinda C. Aldrich, PhD, MPH, associate professor in the departments of medicine, thoracic surgery, and biomedical informatics at Vanderbilt University, discussed recently updated lung screening guidelines from the American Cancer Society and the importance of equity across populations as new guidelines are developed.

While the first ustekinumab biosimilar, Wezlana, was approved in October 2023, a settlement with Johnson & Johnson (J&J) will keep it off the market until 2025, preventing competition, and causing purchasers to pay substantially more for the agent.

The most popular reimbursement content of 2023 included coverage of the shift from the Oncology Care Model to the Enhancing Oncology Model, reactions to the 2024 Medicare Physician Fee Schedule, and concerns around denial of services in Medicare Advantage plans.

While the Enhancing Oncology Model is the successor of the Oncology Care Model, it includes some very real challenges for participating practices, explained Lalan Wilfong, MD, senior vice president of payer and care transformation at The US Oncology Network.

A one-size-fits-all approach to alternative payment models (APMs) often isn’t very fair to community practices, said Miriam Atkins, MD, FACP, president of the Community Oncology Alliance.

Coverage from The US Oncology Network Payer Transformation Summit, held September 27-29, 2023, in Atlanta, Georgia.

This article examines how CMS’ adjustment for social risk factors affects the Medicare Advantage Star Ratings and the type of contracts affected by the adjustment.

In the phase 3 EV-302/KEYNOTE-A39 clinical trial, the antibody-drug conjugate enfortumab vedotin plus PD-1 inhibitor pembrolizumab nearly doubled both median overall survival and progression-free survival compared with chemotherapy.

David Fajgenbaum, MD, MBA, MSc, cofounder of Every Cure, shared that the organization is able to reduce clinical trial costs to $1 to $5 million per drug trial, and that clinical trials are not always necessary to expand a drug's indication.

The bipartisan bill would help lower Medicare costs and improve quality of care, according to the National Association of ACOs.

A new report from AHIP shows that Medicare Advantage outperformed traditional Medicare on several clinical quality measures, including preventive screenings. However, debate continues over these plans’ cost efficiency and impact on the financial sustainability of rural hospitals.

The commercial market got slightly less competitive while the Medicare Advantage market got a little more competitive, but both markets remain highly concentrated.

Activity to regulate pharmacy benefit managers (PBMs) has started in the states and is trickling up to the federal level, said Ted Okon, MBA, executive director of the Community Oncology Alliance.

Leading payer and health system stakeholders reviewed literature and shared insights on the value of real-time continuous glucose monitoring (rtCGM) in type 2 diabetes (T2D) population health.

The company is changing the way it prices prescription drugs and providing more transparency, which has been one focus of pharmacy benefit manager regulation efforts.