Health Care Cost

Some challenges linking medication adherence to medical cost offsets include the potential of reverse causality, omitted variable bias, how adherence is measured between studies, and the outdated nature of some of the most-cited literature, said Ben Urick, PharmD, PhD, principal health outcomes researcher at Prime Therapeutics.

On the first full day of conference activity at AMCP 2023, a morning session examined prior authorization (PA) through a lens of refining the current process and the potential role of clinical trial data in PA criteria.

Minnesota looks to create abortion refuge for patients and providers; Moderna’s expected price single dose of COVID-19 sits at $130; FDA staff sees a "clinical benefit" in Biogen’s ALS drug.

Gov. Mark Gordon sings a ban on the use of abortion pills in Wyoming; a new study shows that Affordable Care Act has reduced racial disparities in health care; California Gov. Gavin Newsom announces a contract to make affordable insulin.

A substantial proportion of families of privately insured children with sickle cell anemia pay more than $100 for essential stroke screenings, a high-value service.

Preventing tobacco use has saved Californians billions, according to recent research.

Biosimilars may not be perfect, but they are, at the very minimum, helping to make cancer therapies a little bit more accessible, said Andre D. Harvin, PharmD, MS, executive director of pharmacy, oncology, Cone Health.

The high court in North Dakota voted to protect abortion in that state; an outside panel of FDA expert advisors voted to support a full approval for Paxlovid; Sanofi follows competitors' price caps for insulin.

Spending on novel therapies in high-risk bladder cancer had minimal impact on Oncology Care Model payments to practices, according to this cohort study and an average performance estimation.

A health system transformational leadership framework and management system made visible and eliminated defects in value and was associated with reduced annual Medicare expenditures and increased quality between 2017 and 2020.

The Biden administration released the list of 27 Medicare Part B drugs that are subject to rebates back to the government for having price increases that rose faster than inflation as well as the removal of out-of-pocket costs for some vaccines covered under Part D.

The authors analyzed cost and utilization changes for sepsis and pneumonia non–COVID-19 episodes prior to and during the pandemic, and during the pandemic for patients with and without COVID-19.

Optimizing utilization of sacubitril/valsartan for treatment of heart failure could improve provider performance in the Bundled Payments for Care Improvement initiative and the Medicare Shared Savings Program.

With the rapid decline in average sales price of reference pegfilgrastim products due to biosimilar competition, health care institutions and payers may grapple with coverage of Neulasta Onpro.

A session at the Association of Community Cancer Centers (ACCC) 2023 Annual Meeting and Cancer Center Business Summit highlighted ongoing issues in oncology policy and payment, from the Cures 2.0 Act to 340B drug reimbursement.

Jeff Hunnicutt, CEO of Highlands Oncology Group, explains the 2 risk options provided under the Enhancing Oncology Model (EOM) and why the mandatory downside risk might give pause to practices that saw some success in the Oncology Care Model.

Panelists at the keynote session of the Value-Based Insurance Design Summit highlighted what their organizations are doing in health equity.

A new resource from the National Alliance of Healthcare Purchaser Coalitions aims to help plan sponsors adopt biosimilars into their pharmacy benefit plans.

Samyukta Mullangi, MD, MBA, oncology fellow at Memorial Sloan Kettering Cancer Center and incoming medical director at Thyme Care, spoke on financial toxicity, heterogeneity of cancer, and other complex factors in oncology care systems that may perpetuate disparities in health care outcomes and delivery among patients.

Cyber attacks on health care are raising cyber insurance costs; Democrats and Republicans clash over what constitutes a cut vs a reform; rural hospitals begin conversion under a new federal payment program.

A roundup of the latest biosimilar news from The Center for Biosimilars®.

Stephen M. Schleicher, MD, MBA, chief medical officer at Tennessee Oncology, discusses the present state of value-based oncology care and what the future may bring when the Enhancing Oncology Model kicks off on July 1.

The FDA approved the first drug for the rare disease Friedreich’s ataxia; House Republicans seek information from pharmacy benefit managers (PBMs); FDA panel narrowly supports respiratory syncytial virus (RSV) vaccine for older adults.

David A. Eagle, MD, New York Cancer & Blood Specialists, discusses the present state of treatment for cancer, which often sees patient financial concerns outweighed by the cost of treatment.

A Cardinal Health report reviewed the potential impact biosimilars will have in rheumatology, gastroenterology, dermatology, and ophthalmology.

Utilizing real-world evidence that applies to the specific care needs of certain patient populations can promote timely decision-making among payers and providers on the use of effective cancer therapies available on the market, said panelists at the 2022 Patient-Centered Oncology Care® (PCOC) meeting.

There are 2 ranibizumab biosimilars approved in the United States, and with more ranibizumab and the first aflibercept biosimilars on the horizon, gaps in knowledge among retinal physicians should be addressed.

An increased risk of hospitalization for more than 6 days due to community-acquired infections was associated with male sex and admittance to the Pulmonology or Surgery department, with risk shown to differ according to pathogen.

Social Security and Medicare spending could double by 2023; FDA panel experts want naloxone to be available over the counter after the drug information is revised; Moderna announced its COVID-19 vaccines will stay free, and the Biden administration might keep tests and treatments free for the uninsured.

Unrecognized disease progression is associated with higher health care costs both for patients with end-stage kidney disease and late-stage (stages G4-G5) chronic kidney disease.