April 23rd 2025
Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
Cost Effectiveness Varies in TAS-102 Plus Bevacizumab Third Line Treatment
October 10th 2024Patients with refractory metastatic colorectal cancer could use trifluridine/tipiracil (TAS-102) plus bevacizumab as a cost effective third line treatment in China but the same was not found in the United States and United Kingdom.
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Defining Value in Oncology Pharmacy: Insights on Care and Costs
October 10th 2024The theme of our inaugural regional Institute for Value-Based Medicine® event in Boston was, “Elevating Value in Cancer Care,” and one of the 4 panel discussions focused on the important contributions of pharmacists and the practice of pharmacy to the oncology space.
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Managing Germline Mutations in Hereditary Breast Cancer Risk
October 7th 2024Hereditary breast cancers are caused by germline mutations, which are genetic mutations inherited at conception and so called because they originate in germ cells, those that develop into reproductive cells and become eggs in female individuals and sperm in male individuals.
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The Price of Progress: Understanding Innovation and Affordability of Prescription Drugs
October 7th 2024Economic incentives and patent protections drive development of innovative medications. Drug prices are determined by consumer demand, not production costs. Therefore, governmental regulation risks future investment in research and development.
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Corporate Accountability and Public Health: Sackler Ruling and Treatment Gaps in the Opioid Crisis
October 2nd 2024The Supreme Court’s decision, paired with the newest data demonstrating the public impact of the opioid crisis, illustrates the legal potential in addressing the crisis and the ongoing public health challenges of treatment access.
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Lower Drug Costs on the Horizon for Medicare Beneficiaries
September 30th 2024Average Medicare drug premiums for older Americans will drop next year for those enrolled in traditional Medicare plans or who have coverage through Medicare Advantage, with opinions divided along party lines on the economic implications.
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At-Home Cholesterol Screening Accessible Through New Program
September 30th 2024The innovative program from the Family Heart Foundation includes being able to order a free test kit for an at-home blood lipid panel and track your results online, as well as the ability to discuss the findings with care navigators and health care providers.
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Role of the Pharmacist in the Care Team to Contain Costs in Oncology
September 28th 2024The pharmacist is a critical member of the care team to help manage patients on treatment and contain costs of cancer care, said Kirollos S. Hanna, PharmD, BCPS, BCOP, FACCC, director of pharmacy, Minnesota Oncology.
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Uplifting Rural Behavioral Health: Leveraging Grants for Lasting Impact
September 27th 2024This interview accompanies the fourth podcast in our National Recovery Month series with Amy Herschell, PhD, associate vice president, Program Implementation and Evaluation, Community Care Behavioral Health Organization, part of the UPMC Insurance Services Division, and Jessica Meyers, MSEd, senior advisor for implementation, UPMC Center for High-Value Health Care.
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State Policy Opportunities to Control Health Care Prices: A CPR Report
September 25th 2024Catalyst for Payment Reform (CPR) explores stakeholder perspectives in Florida, Michigan, and Nevada, revealing both the challenges and opportunities states face in reforming health care pricing structures.
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New FTC Lawsuit Against PBMs Has Broad Implications for Pharmaceuticals, Ted Okon Says
September 24th 2024Ted Okon, MBA, executive director of the Community Oncology Alliance, spoke with The American Journal of Managed Care® about how the Federal Trade Commission's (FTC) lawsuit against pharmacy benefit managers (PBMs) could affect the future of pharmaceuticals and oncology.
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Extended Time in ED Linked to Reported Racial Discrimination and Patient Dissatisfaction
September 24th 2024Boarding times in the emergency department (ED) have risen nationally, but the implications for health equity have remained understudied. This study investigated whether prolonged ED boarding contributed to perceived racial discrimination and dissatisfaction with care.
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Medicare High-Value Drug List Model Could Lower Out-of-Pocket Costs for 4 in 10 Beneficiaries
September 23rd 2024The proposed Medicare High-Value Drug List Model, also known as the Medicare $2 Drug List, could have modestly reduced out-of-pocket costs for 38% of beneficiaries if implemented in 2021.
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CMMI's Latest Payment Models Address Health Disparities, but Challenges Remain
September 22nd 2024"As CMMI continues to test new equity adjustments, it is important that changes be grounded in scientific principles with extensive testing and validation to ensure the tightest linkage to social needs and health outcomes for underserved communities across the entire US," authors wrote.
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